title: Complications related to intraoperative transesophageal echocardiography in liver transplantation.
abstract: OBJECTIVE
  Intraoperative transesophageal echocardiography (TEE) has commonly been used for evaluating cardiac function and monitoring hemodynamic parameters during complex surgical cases. Anesthesiologists may be dissuaded from using TEE in orthotopic liver transplantation (OLT) out of concern about rupture of esophageal varices. Complications associated with TEE in OLT were evaluated.
  
  
  METHODS
  We retrospectively reviewed charts and TEE videos of all OLT cases from January 2003 through December 2013 at Mayo Clinic (Jacksonville, Florida).
  
  
  RESULTS
  Of the 1811 OLTs performed, we identified 232 patients who underwent intraoperative TEE. Esophageal variceal status was documented during presurgical esophagogastroduodenoscopy in 230 of the 232 patients. Of these, 69 (30.0 %), had no varices; 113 (49.1 %), 41 (17.8 %), and 7 (3.0 %) had grades I, II, and III varices, respectively. Two patients (0.9 %) had no EGD performed because of acute liver failure. During OLT, 1 variceal rupture (0.4 %) occurred after placement of an oral gastric tube and TEE probe; the patient required intraoperative variceal banding. Most patients had preexisting coagulopathy at the time of probe placement. The mean (SD) laboratory test results were as follows: prothrombin time, 21.7 (6.6) seconds; international normalized ratio, 1.9 (1.3); partial thromboplastin time, 43.8 (13.3) seconds; platelet, 93.7 (60.8) × 1000/μL; and fibrinogen, 237.8 (127.6) mg/dL.
  
  
  CONCLUSIONS
  TEE was a relatively safe procedure with a low incidence of major hemorrhagic complications in patients with documented esophagogastric varices and coagulopathy undergoing OLT. It appeared to effectively disclose cardiac information and allowed rapid reaction for proper patient management.
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224 USA.
authors.forename: Sher-Lu
authors.initials: SL
authors.lastname: Pai
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224 USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Aniskevich
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224 USA.
authors.forename: Neil G
authors.initials: NG
authors.lastname: Feinglass
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224 USA.
authors.forename: Beth L
authors.initials: BL
authors.lastname: Ladlie
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224 USA.
authors.forename: Claudia C
authors.initials: CC
authors.lastname: Crawford
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224 USA.
authors.forename: Prith
authors.initials: P
authors.lastname: Peiris
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224 USA.
authors.forename: Klaus D
authors.initials: KD
authors.lastname: Torp
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224 USA.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Shine
keywords: Coagulopathy; End-stage liver disease; Esophageal varices; Variceal bleed