Transesophageal echocardiography

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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.

Overview

Indications

Surgical procedure

Preoperative management

Patient evaluation

System Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Operating room setup

Patient preparation and premedication

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

Regional and neuraxial techniques

Intraoperative management

Monitoring and access

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.

Emergence

Postoperative management

Disposition

PACU

Pain management

Potential complications

Procedure variants

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

References