Perioperative use of transesophageal echocardiography by anesthesiologists: Impact in noncardiac surgery and in the intensive care unit

  • André Y. DenaultEmail author
  • Pierre Couture
  • Sylvie McKenty
  • Daniel Boudreault
  • François Plante
  • Roger Perron
  • Denis Babin
  • Jean Buithieu
Cardiothoracic Anesthesia, Respiration and Airway



The American Society of Anesthesiologists (ASA) has published practice guidelines for the use of perioperative transesophageal echocardiography (TEE) but the role and impact of TEE performed by anesthesiologists outside the cardiac operating room (OR) is still poorly explored. We report our experience in the use of TEE in the noncardiac OR, the recovery room and in the intensive care unit (ICU) in a university hospital, and analyze the impact of TEE on clinical decision making.


Two hundred fourteen patients were included and TEE indications were classified prospectively according to the ASA guidelines. The examinations and data sheets were reviewed by two anesthesiologists with advanced training in TEE. For each examination, it was noted if TEE altered the management according to five groups: 1) changing medical therapy; 2) changing surgical therapy; 3) confirmation of a diagnosis; 4)positioning of an intravascular device; and 5) TEE used as a substitute to a pulmonary artery catheter.


Eighty-nine (37%), 67 (31%) and 58 (27%) patients had category I, II and III indications. The impact was more significant in category I where TEE altered therapy 60% of the time compared with 31% and 21% for categories II and III (P < 0.001). The most frequent reason for changing management was a modification in medical therapy in 53 instances (45%).


Our results confirm a greater impact of TEE performed by anesthesiologists on clinical management for category I compared to category II and III indications in the noncardiac OR surgical setting and in the ICU.


Intensive Care Unit Recovery Room Transesophageal Echocardiography Noncardiac Surgery Montreal Heart Institute 
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L’utilisation périopératoire de l’échocardiographie transœsophagienne par les anesthésiologistes : Les répercussions en chirurgie non cardiaque et à l’unité des soins intensifs



L’American Society of Anesthesiologists (ASA) a publié lelignes directrices pour l’utilisation périopératoire de l’échocardiographie transœsophagienne (ETO), mais le rôle et l’impact de l’ETO réalisée par les anesthésiologistes à l’extérieur de la salle d’opération (SO) sont encore peu connus. Nous présentons notre expérience de l’usage de l’ETO dans une SO non cardiaque, dans la salle de réveil et à l’unité des soins intensifs (USI) d’un hôpital universitaire. Aussi, nous analysons l’impact de l’ETO sur la prise de décision en clinique.


Deux cent quatorze sujets ont participé à l’étude et les indications d’ETO ont été classifiées prospectivement selon les lignes directrices de l’ASA. Les examens et les fiches techniques ont été passées en revue par deux anesthésiologistes de formation avancée en ETO. Pour chaque examen, on a noté si l’ETO modifiait le traitement en regard de cinq groupes: 1) modification de la thérapie médicale 2) modification de la thérapie chirurgicale 3) confirmation du diagnostic 4) installation d’une sonde intravasculaire 5) usage de l’ETO comme substitut d’un cathéter artériel pulmonaire.


Quatre-vingt-neuf (37 %), 67 (31 %) et 58 (27 %) patients présentaient des indications de catégorie I, II et III. L’ETO a eu un impact plus significatif pour la catégorie I où elle modifiait la thérapie dans 60 % des cas comparativement à 31 % et à 21 % pour les catégories II et III (P < 0,001). C’est la modification de la thérapie médicale qui apparaît comme la raison principale de changement du traitement avec 53 cas (45 %).


Nos résultats confirment une plus grande répercussion de l’ETO réalisé par les anesthésiologistes sur le traitement clinique pour les indications de catégorie I comparées à celles de catégories II et III dans le contexte chirurgical d’une SO non cardiaque et de l’USI.


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Copyright information

© Canadian Anesthesiologists 2002

Authors and Affiliations

  • André Y. Denault
    • 1
    Email author
  • Pierre Couture
    • 1
  • Sylvie McKenty
    • 2
  • Daniel Boudreault
    • 2
  • François Plante
    • 2
  • Roger Perron
    • 2
  • Denis Babin
    • 1
  • Jean Buithieu
    • 3
  1. 1.Department of AnesthesiologyMontreal Heart InstituteMontrealCanada
  2. 2.Department of AnesthesiologyCentre Hospitalier de l’Université de Montreal (CHUM)MontrealCanada
  3. 3.Department of MedicineCentre Hospitalier de l’Université de Montreal (CHUM)MontrealCanada

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