• Thomas Kratz, Thorsten Steinfeldt, Maik Exner, Marco Campo Dell Orto, Nina Timmesfeld, Caroline Kratz, Martin Skrodzki, Hinnerk Wulf, and Martin Zoremba.
• Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany. Electronic address: thkratz21@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2017 Apr 1; 31 (2): 602-609.

ObjectivesFocused transthoracic echocardiography (TTE) is used perioperatively for surgical patients. Intraoperative application of TTE is feasible, but its benefits remain unclear. The intention of this study was to investigate the effect of intraoperative TTE on the management of high-risk noncardiac surgery patients.DesignA prospective interventional study.SettingSingle-center university hospital.ParticipantsFifty consecutive hemodynamically unstable high-risk patients anesthetized for noncardiac surgery.InterventionsFocused TTE was performed on hemodynamically unstable anesthetized patients whenever circulatory instability (defined as hypotension or low cardiac output) occurred intraoperatively. A cardiac output monitoring system using pulse contour analysis was established before induction of anesthesia. The intended therapy for stabilizing the patient was documented; however, the management actually administered was guided by the results of the TTE. Differences between the 2 lines of management were documented and analyzed.Measurements And Main ResultsIntraoperative TTE was applied successfully in all 50 unstable patients. In 33 patients (66%, 95% confidence interval, 52.11-77.61) TTE led to a change of management. Altogether, 82 episodes of hemodynamic instability were recorded, including 38 episodes (46.34%, 95% confidence interval, 35.95-57.06) in which TTE led to a change of treatment. The most common pathologic finding was hypovolemia (66%); in contrast, in 22%, right-heart overload or right-heart failure (4%) was detected.ConclusionsFocused TTE by anesthesiologists can provide new information that may alter the hemodynamic management of unstable high-risk noncardiac surgery patients in the operating room.Copyright © 2017 Elsevier Inc. All rights reserved.

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