Abstract
No data exists for the optimal head position during transesophageal echocardiography (TEE) probe insertion in children. Turning the head to the side closes the ipsilateral pyriform sinus and dilates the contralateral pyriform sinus, theoretically making probe insertion safer and easier. In this study, 94 children (weight, ≤10 kg) undergoing TEE during heart surgery between March 2000 and August 2001 were studied. The head position was either midline or left. A scale was devised to grade the resistance during probe insertion: grade 1 (none), grade 2 (mild), grade 3 (moderate), grade 4 (severe), and grade 5 (inability to insert probe). Probe insertion was midline in 38 and left in 56 of the children. Mild or no resistance was encountered in 86% of the head left versus 63% of the head midline children (p = 0.002). Probe insertion was easier with the head left in three subgroups: I (weight, >5 kg), II (weight, 4–5 kg), and III (weight, <4 kg). The difference was statistically significant only for subgroup III (p = 0.0001). Insertion failed in four children with the head in the midline position but was successful when the head was turned leftward. Children undergoing TEE who weigh less than 10 kg should have the head positioned to the side rather than in the midline position during probe insertion. If insertion is unsuccessful or difficult with the head in the midline position, the authors recommend turning the head to the side and reattempting probe insertion.
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References
Aviv JE, Di Tullio MR, Homma S et al (2004) Hypopharyngeal perforation near-miss during transesophageal echocardiography. Laryngoscope 114:821–826
Ayres NA, Miller-Hance W, Fyfe DA et al (2005) Pediatric Council of the American Society of Echocardiography Indications and guidelines for performance of transesophageal echocardiography in the patient with pediatric acquired or congenital heart disease: report from the task force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr 18:91–98
Baylor College of Medicine, The Bobby R. Alford Department of Otorhinolaryngology, Review of anatomy: oral cavity and pharynx. Retrieved at www.bcm.edu/oto/studs/anat/oral.html
Logemann JA, Kahrilas PJ, Kobara M, Vakil NB (1989) The benefit of head rotation on pharyngoesophageal dysphagia. Arch Phys Med Rehabil 70:767–771
Ghafoor AU, Schmitz ML, Mayhew JF (2004) Esophageal mucosal tear from a transesophageal echocardiography probe despite preliminary assessment via esophagoscopy in a patient with esophageal disease. J Cardiothorac Vasc Anesth 18:78–79
Massey SR, Pitsis A, Mehta D, Callaway M (2000) Oseophageal perforation following perioperative transesophageal echocardiography. Br J Anaesth 84:643–646
Moore KL, Dalley AF (1999) Neck–Alimentary layer of the cervical viscera. In: Clinically oriented anatomy, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 1054–1055
Muhiudeen-Russell IA, Miller-Hance WC, Silverman NH (1998) Intraoperative transesophageal echocardiography for pediatric patients with congenital heart disease. Anesth Analg 87:1058–1076
Muhiudeen-Russell IA, Miller-Hance WC, Silverman NH (2001) Unrecognized esophageal perforation in a neonate during transesophageal echocardiography. J Am Soc Echocardiogr 14:747–749
Spahn DR, Schmid S, Carrel T et al (1995) Hypopharynx perforation by a transesophageal echocardiography probe. Anesthesiology 82:581–583
Stumper O, Sutherland GR (1994) Transesophageal Echocardiography in Congenital Heart Disease. Edward Arnold, London, pp 24–25
Tsukamoto Y (2000) CT study of closure of the hemipharynx with head rotation in a case of lateral medullary syndrome. Dysphagia 15:17–18
http://training.seer.cancer.gov/ss_module06_head_neck/unit02_sec08_anatomy.html
http://www.meddean.luc.edu/lumen/meded/Radio/curriculum/ENT/structure_ent.htm
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Mart, C.R., Rosen, K.L. Optimal Head Position During Transesophageal Echocardiographic Probe Insertion for Pediatric Patients Weighing Up to 10 kg. Pediatr Cardiol 30, 441–446 (2009). https://doi.org/10.1007/s00246-008-9373-2
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DOI: https://doi.org/10.1007/s00246-008-9373-2