Anesth Analg 2003;96:1527-1528
© 2003 International Anesthesia Research Society
LETTERS TO THE EDITOR
TEE Probe via Endoscopy Mask: The Right Thing at the Wrong Time?
Felipe Urdaneta, MD
University of Florida, College of Medicine, Gainesville, FL
To the Editor:
Transesophageal echocardiography (TEE) is one of the most important technological advances in cardiovascular medicine. When used appropriately by experienced and trained personnel, it has become an integral component of cardiac surgical patient care and is increasingly used in noncardiac surgery and intensive care. The current applications for TEE are numerous and expanding.
Shiga et al. (1) report the use of a plastic mask with a membrane to introduce the TEE probe prior to tracheal intubation. They suggest that TEE be used in patients with coronary artery disease or hypertension, because the most common adverse cardiovascular event related to intubation is probably ischemia.
TEE may offer advantages over other traditional monitors such as electrocardiography. However, current guidelines for echocardiography from the ACC/AHA place myocardial ischemia as a category IIb indication (2), meaning its usefulness or efficacy is less well established by evidence or opinion. Transthoracic stress echocardiography (TTE) has been accepted as the technique of choice for this purpose; TEE is recommended when image quality is poor or inadequate (2). Probe placement might not only cause discomfort, but it may interfere with airway instrumentation and predispose to aspiration. Furthermore, the population for which Shiga et al. recommend TEE may already have preexisting wall motion abnormalities, and they also do not state who is going to perform the examination and how patient management is going to be influenced by the information obtained from preintubation TEE. Considering the abundance of patients with cardiac disease, I fail to identify any clinical benefit of the described method of ischemia detection during the induction period.
References
- Shiga T, Inoue T, Wajima Z, Ogawa R. Insertion of the transesophageal echocardiography probe via endoscopy mask. Anesth Analg 2002; 95: 561–3.[Abstract/Free Full Text]
- Cheitlin MD, Alpert JS, Armstrong WF, et al. ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practical Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Circulation 1997; 95: 1686–744.[Free Full Text]
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