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Der Anaesthesist

, Volume 64, Issue 9, pp 669–682 | Cite as

Perioperative transösophageale Echokardiographie außerhalb der Kardiochirurgie

Update
  • D. Wally
  • C. Velik-SalchnerEmail author
Allgemeinanästhesie

Zusammenfassung

Ziel der Arbeit

Die Vermittlung von Kenntnissen zur fokussierten transösophagealen Echokardiographie (TEE) als Diagnostikum bei nichtkardiochirurgischen Patienten ist das Ziel dieser Arbeit. Die transösophageale Echokardiographie (TEE) ist perioperativ sehr hilfreich, da sie eine rasche echokardiographische Untersuchung ohne Behinderung des Operationsfelds bzw. bei eingeschränkten transthorakalen Untersuchungsbedingungen ermöglicht. Neue Empfehlungen zur perioperativen TEE mit erweiterten Standardschnitten und dem daraus abgeleiteten verkürzten Untersuchungsgang als Grundlage für eine orientierende Basisuntersuchung waren ausschlaggebend für diese Arbeit.

Material und Methoden

Hintergrund ist die zu diesem Thema publizierte Literatur (Peer-Review-Arbeiten aus PubMed).

Ergebnisse

Die TEE bei nichtkardiochirurgischen Patienten hat im Wesentlichen 2 Einsatzgebiete: 1. die Abklärung der akuten perioperativen hämodynamischen Instabilität in OP, Schockraum und auf der Intensivstation, 2. die geplante intraoperative Überwachung, wenn aufgrund der Art des Eingriffs oder aufgrund bekannter oder vermuteter kardiovaskulärer Vorerkrankungen des/r Patienten/in mit schweren hämodynamischen, pulmonalen oder neurologischen Komplikationen gerechnet werden muss. Im Jahr 2013 wurden 11 relevante Standardschnitte als Grundlage für die Basisuntersuchung außerhalb der Herzchirurgie definiert. Die konsequente Einhaltung dieses verkürzten Untersuchungsgangs sollte bei jedem Patienten erfolgen. Bei speziellen Fragestellungen kann eine Erweiterung des Untersuchungsgangs nötig werden.

Diskussion

Die perioperative TEE ist auch bei nichtkardiochirurgischen Patienten mittlerweile unverzichtbar. Mithilfe der TEE ist es möglich, eine lebensbedrohliche perioperative hämodynamische Instabilität innerhalb weniger Minuten abzuklären. Weiterhin kann das hämodynamische Management von Hochrisikopatienten/innen erleichtert werden. Entsprechende Qualifikation und Weiterbildung sind notwendig, um die Kompetenz der Untersucher/innen sicherzustellen.

Schlüsselwörter

Perioperative Phase Monitoring, intraoperativ Hämodynamik Ventrikuläre Funktion Embolie und Thrombose 

Perioperative transesophageal echocardiography in non-cardiac surgery

Update

Abstract

Aim

The aim of this article is to impart knowledge concerning focused transesophageal echocardiographic examination (TEE) for non-cardiac surgery which is an essential part of perioperative monitoring. It allows a rapid echocardiographic examination without interference with the surgical field or under limited transthoracic examination conditions. New recommendations for a comprehensive perioperative TEE examination with expanded standard views and the recently published consensus statement for a shortened baseline examination were crucial for this study.

Material and methods

The background is the peer-reviewed literature from PubMed.

Results

Apart from cardiac surgery TEE has two main applications: firstly, the evaluation of patients developing acute life-threatening hemodynamic instability in the operating room, in the emergency room or in the intensive care unit (ICU). Secondly, TEE is used as planned intraoperative monitoring when severe hemodynamic, pulmonary or neurological complications are expected because of the type of surgery or due to the cardiopulmonary medical history of the patient. In 2013 a total of 11 relevant standard views were defined for the basic perioperative TEE examination in non-cardiac surgery. These 11 views should be performed for each patient. Appropriate extension to a comprehensive examination may be necessary if complex pathology is obvious.

Discussion

Even in non-cardiac surgery TEE is an important tool allowing clarification of a life-threatening perioperative hemodynamic instability within a few minutes. Furthermore, the hemodynamic management of high-risk patients can be facilitated. Appropriate qualification and continuous training are necessary in order to assure the competence of the examiner.

Keywords

Perioperative period Monitoring, intraoperative Hemodynamics Ventricular function Embolism and thrombosis 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

D. Wally und C. Velik-Salchner geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Tieren oder Menschen.

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© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Universitätsklinik für Anästhesie und Intensivmedizin, Department für Operative MedizinMedizinische Universität InnsbruckInnsbruckÖsterreich

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