Current practice patterns for adult perioperative transesophageal echocardiography in the United States.

TRANSESOPHAGEAL echocardiography (TEE) was first introduced to the operating room in 1980 when M-mode measurements of left ventricular diameter were used to monitor changes in myocardial function. The subsequent development, in the mid 1980s, of transesophageal transducers capable of real-time, two-dimensional imaging and color Doppler flow mapping resulted in a powerful new tool for the determination of cardiac structure and function. Although these new TEE capabilities were initially limited to research centers, their applicability to the perioperative care of patients with complicated cardiovascular disease quickly became apparent. In a 1992 survey, Poterack found that TEE was being employed perioperatively in many of the academic anesthesiology programs in the United States. Since 1990, the use of perioperative TEE has spread beyond academic medical centers to the everyday care of cardiac surgical patients. Accordingly, today, many anesthesiologists have undertaken advanced training in the performance and interpretation of echocardiographic studies. Growing interest in this subject prompted the formulation of practice guidelines for perioperative TEE in 1996 by a joint task force of the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists (ASA/SCA). The recently defined standards for a comprehensive intraoperative TEE examination also included substantial contributions from the anesthesiology community. Despite these developments, there are no reports that describe the extent to which TEE has been incorporated into the daily perioperative care of patients across the spectrum of anesthesia practice environments existent in the United States. Similarly, no recent data are available regarding the credentialing standards that anesthesiologists have adopted or the training pathways they have chosen. We initiated the current study to determine the frequency with which TEE is currently employed in the perioperative care of surgical patients, to characterize the involvement of anesthesiologists in the provision of this service, and to describe the practice patterns of anesthesiologists who use TEE.