• R J Suriani, S Neustein, L Shore-Lesserson, and S Konstadt.
• Department of Anesthesiology, Mount Sinai Medical Center, New York, NY, USA.
• J. Cardiothorac. Vasc. Anesth. 1998 Jun 1;12(3):274-80.

ObjectiveTo investigate the use and impact of transesophageal echocardiography (TEE) during noncardiac surgery.DesignRetrospective study.SettingA university teaching hospital.Participants And InterventionsThe medical records and the videotapes of 123 intraoperative TEE examinations were reviewed.Measurements And Main ResultsTEE was used for non-consultative indications in 68 patients and in consultation in 55 patients. Information that would not have been detected intraoperatively by other means included intracardiac defects, valvular and aortic pathology, the presence or absence of ventricular dysfunction or intracardiac thrombi, and embolization during surgery. Findings during the initial TEE examination and the TEE evaluation of intraoperative events resulted in a major impact on patient management in 15% of patients. The majority of patients in whom TEE had any impact (the sum of major, minor, and limited impact groups) were classified as American Society of Anesthesiologists (ASA) class 3 or 4. Patients in whom TEE had any impact were significantly older than patients in whom TEE had no impact (66.5 +/- 13.4 years v 58.1 +/- 16.2 years; p < 0.05). No patient experienced a complication related to intraoperative TEE.ConclusionIt appears that TEE in patients undergoing noncardiac surgery is efficacious in rapidly disclosing new findings and information during periods of hemodynamic instability. It may have a significant impact on intraoperative patient management and may be beneficial in patients older than 66 years of age.

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