View source for Transesophageal echocardiography

{{Infobox surgical procedure
| anesthesia_type = MAC
| airway = Natural airway
| lines_access = 1 PIV
| monitors = Standard ASA
| considerations_preoperative = 
| considerations_intraoperative = 
| considerations_postoperative = 
}}'''Transesophageal echocardiography''' ('''TEE''') is diagnostic procedure performed to evaluate the structure and function of the heart. TEE uses a specialized ultrasound probe which is inserted into the esophagus and pointed anteriorly to capture images and measurements of the heart. TEE may be performed as a standalone procedure, but is also routinely used intraoperatively in cardiac surgeries.

== Overview ==

=== Indications<!-- List and/or describe the indications for this surgical procedure. --> ===

=== Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. --> ===

== Preoperative management ==

=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
{| class="wikitable"
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!System
!Considerations
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|Airway
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|Neurologic
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|Cardiovascular
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|Pulmonary
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|Gastrointestinal
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|Hematologic
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|Renal
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|-
|Endocrine
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|-
|Other
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|}

=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===

=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===

=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
Lidocaine 4% spray into back of oropharynx. Ask patient to gargle for 10 seconds.

=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===

== Intraoperative management ==

=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===

=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
Because patients requiring TEE typically have poor cardiac function, hemodynamically stable cardiac induction is preferred. This can be achieved with small amounts of propofol, midazolam, and fentanyl. That said, midazolam (0.5-1 mg) followed by ketamine (20-30 mg) is a very popular induction of choice in patients with critically low EF and tenuous respiratory status to avoid afterload reduction and to avoid hypoventilation worsening right heart function.

=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
Supine with head at 30 degrees, slight tilt to left.

Bite block is placed for TEE probe.

=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
Insertion of TEE probe is facilitated with jaw thrust. This is the most stimulating part of procedure by far. Minimal anesthesia is generally required for maintenance.

=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===

== Postoperative management ==

=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
PACU

=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===

=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===

== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==

{| class="wikitable wikitable-horizontal-scroll"
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!Variant 1
!Variant 2
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|Unique considerations
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|EBL
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|Postoperative disposition
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|Pain management
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== References ==

[[Category:Surgical procedures]]