Transesophageal echocardiography

Transesophageal echocardiography

Anesthesia type	MAC
Airway	Natural airway
Lines and access	1 PIV
Monitors	Standard ASA
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
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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.

Preoperative management

Patient evaluation

System	Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Patient preparation and premedication

Lidocaine 4% spray into back of oropharynx. Ask patient to gargle for 10 seconds.

Intraoperative management

Induction and airway management

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

Supine with head at 30 degrees, slight tilt to left.

Bite block is placed for TEE probe.

Maintenance and surgical considerations

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.

Postoperative management

Disposition

PACU

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications