• María Carolina Cabrera Schulmeyer, Emilio Santelices, Raúl Vega, and Silvia Schmied.
• Department of Anesthesiology, Air Force Hospital of Santiago, and University of Valparaiso, Santiago, Chile. Carol218@vtr.net
• J. Cardiothorac. Vasc. Anesth. 2006 Dec 1;20(6):768-71.

ObjectiveThe purpose of this study was to test if parameters measured by intraoperative transesophageal echocardiography (TEE) could be useful to evaluate the hemodynamic status of high-risk cardiovascular patients and if this information was sufficient to make changes in intraoperative management.DesignProspective clinical study.SettingSingle-university hospital.ParticipantsNinety-eight patients undergoing noncardiac surgery.InterventionsEvery patient was assessed with a baseline examination of 2-dimensional, color, pulsed, and continuous Doppler images. Intraoperative changes in any of the evaluated and measured parameters led to a specific change according to the protocol.Measurements And Main ResultsAfter continuous monitoring with TEE during surgery, all patients were assigned to 1 of the following groups: (1) TEE was of no use, (2) TEE-directed intraoperative management changes, (3) intraoperative TEE-directed changes in postoperative management, and (4) TEE successfully used as a substitute for pulmonary artery catheter monitoring. Two patients (2%) were assigned to group 1, 47 (48%) patients to group 2, 25 (25%) patients to group 3, and 24 (24%) patients to group 4. The most frequent modifications in intraoperative management were changes in drug therapy and fluid administration. Postoperative management changes were mostly made because of new diagnosis (14%) and new left ventricular wall motion abnormalities (9%).ConclusionThese results strongly suggest that objective measurements made by intraoperative TEE are effective in unveiling relevant clinical findings and useful information in high-risk patients undergoing noncardiac surgery.

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