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

L’utilisation périopératoire de l’échocardiographie transœsophagienne par les anesthésiologistes : Les répercussions en chirurgie non cardiaque et à l’unité des soins intensifs

Canadian Journal of Anesthesia volume 49, Article number: 287 (2002) Cite this article

Abstract

Background

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.

Methods

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.

Results

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%).

Conclusion

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.

Résumé

Contexte

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.

Méthode

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.

Résultats

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 %).

Conclusion

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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Affiliations

  1. Department of Anesthesiology, Montreal Heart Institute, 5000 Bélanger Street East, H1T 1C8, Montreal, Quebec, Canada

    André Y. Denault, Pierre Couture & Denis Babin

  2. Department of Anesthesiology, Centre Hospitalier de l’Université de Montreal (CHUM), Hôpital Notre-Dame, Montreal, Quebec, Canada

    Sylvie McKenty, Daniel Boudreault, François Plante & Roger Perron

  3. Department of Medicine, Centre Hospitalier de l’Université de Montreal (CHUM), Hôpital Notre-Dame, Montreal, Quebec, Canada

    Jean Buithieu

Authors
  1. André Y. Denault
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  2. Pierre Couture
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  3. Sylvie McKenty
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  4. Daniel Boudreault
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  5. François Plante
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  6. Roger Perron
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  7. Denis Babin
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  8. Jean Buithieu
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Correspondence to André Y. Denault.

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Denault, A.Y., Couture, P., McKenty, S. et al. Perioperative use of transesophageal echocardiography by anesthesiologists: Impact in noncardiac surgery and in the intensive care unit. Can J Anesth 49, 287 (2002). https://doi.org/10.1007/BF03020529

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  • DOI: https://doi.org/10.1007/BF03020529

Keywords

  • Intensive Care Unit
  • Recovery Room
  • Transesophageal Echocardiography
  • Noncardiac Surgery
  • Montreal Heart Institute