Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA.
Can J Anaesth. 2018 Apr;65(4):381-398. doi: 10.1007/s12630-017-1017-7. Epub 2017 Nov 17.
The use of transesophageal echocardiography (TEE) has evolved to include patients undergoing high-risk non-cardiac procedures and patients with significant cardiac disease undergoing non-cardiac surgery. Implementation of basic TEE education in training programs has increased across a broad spectrum of procedures in the perioperative arena. This paper describes the use of perioperative TEE in non-cardiac surgery and provides an overview of the basic TEE examination.
Perioperative TEE is used to monitor hemodynamic parameters in non-cardiac procedures where there is a high risk of hemodynamic instability. Its use extends to include moderate-risk procedures for patients with significant cardiac diseases such as low ejection fraction, hypertrophic cardiomyopathy, severe valve lesions, or congenital heart disease. Vascular procedures involving the aorta, blunt trauma, and liver transplantation are all examples of procedures that may benefit from TEE. Transesophageal echocardiography examination allows assessment of volume status, ventricular function, diagnosis of gross valvular pathology and pericardial tamponade, as well as close monitoring of cardiac output, response to therapy, and the impact of ongoing surgical manipulation. In patients with unexplained and unexpected hemodynamic instability, "rescue TEE" can be used to help identify the underlying cause.
Perioperative TEE is emerging as a preferred tool to manage hemodynamics in high-risk procedures and in high-risk patients undergoing non-cardiac surgery. A rescue TEE examination protocol is a helpful approach for early identification of the etiology of hemodynamic instability.
经食管超声心动图（TEE）的应用已发展到包括接受高风险非心脏手术和患有严重心脏疾病的患者进行非心脏手术。在围手术期领域的广泛手术中，基础 TEE 教育的实施已在培训计划中得到增加。本文描述了非心脏手术中围手术期 TEE 的使用，并概述了基本 TEE 检查。
围手术期 TEE 用于监测高风险手术中血流动力学不稳定的患者的血流动力学参数。其应用范围扩展到包括患有严重心脏疾病的中度风险手术患者，如射血分数低、肥厚型心肌病、严重瓣膜病变或先天性心脏病。涉及主动脉、钝性创伤和肝移植的血管手术都是可能受益于 TEE 的手术的例子。经食管超声心动图检查可评估容量状态、心室功能、诊断大瓣膜病变和心包填塞，并密切监测心输出量、对治疗的反应以及持续手术操作的影响。对于原因不明和意外的血流动力学不稳定患者，“抢救 TEE”可用于帮助确定潜在原因。
围手术期 TEE 作为管理高危手术和高危非心脏手术患者血流动力学的首选工具正在出现。抢救 TEE 检查方案是早期识别血流动力学不稳定病因的有用方法。
