|Lines and access||
|Primary anesthetic considerations|
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.
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
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.
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.
|Variant 1||Variant 2|