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CARDIOVASCULAR ANESTHESIA

The Adequacy of Basic Intraoperative Transesophageal Echocardiography Performed by Experienced Anesthesiologists

Joseph P. Miller, MD^*, A.-Stephane Lambert, MD, William A. Shapiro, MD, Isobel A. Russell, MD, Nelson B. Schiller, MD, and Michael K. Cahalan, MD

*Department of Anesthesia and Operative Services, Madigan Army Medical Center, Tacoma, Washington; Department of Anesthesia, St. Michael’s Hospital, Toronto, Canada; Departments of Anesthesia and Medicine, University of California, San Francisco, California

Address correspondence and reprint requests to MAJ Joseph P. Miller, Department of Anesthesia and Operative Services, Madigan Army Medical Center, Tacoma, WA 98431. Address e-mail to joseph.p.miller{at}amedd.army.mil

Transesophageal echocardiography (TEE) may improve intraoperative decision-making and patient outcome if it is performed and interpreted correctly. After revising our TEE examination to fulfill the published guidelines for basic TEE practitioners, we prospectively evaluated the ability of our cardiac anesthesiologists (all very experienced with TEE) to record and interpret this revised examination. Educational aids and regular TEE performance feedback were provided to the anesthesiologists. Their interpretations were compared with the independently determined results of experts. Compared with their own historical controls (42% recording rate), all anesthesiologists showed significant improvement in their ability to record a basic intraoperative TEE examination resulting in 81% (P < 0.0001) of all required images being recorded: 88% before cardiopulmonary bypass, 77% immediately after bypass, and 64% after chest closure. Seventy-nine percent of the images recorded at baseline were correctly interpreted, 6% were incorrectly interpreted, and 15% were not evaluated. Our attempt to assess compliance with published guidelines for basic intraoperative TEE resulted in a marked improvement in our intraoperative TEE practice. Most, but not all, standard cross-sections are recorded or interpreted correctly, even by highly experienced and motivated practitioners.

Implications: Experienced cardiac anesthesiologists can obtain and correctly interpret most basic intraoperative transesophageal echocardiograms.

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