Echocardiography For the Anesthesiologist

use of 3-dimensional (3-D) echocardiography. Basic Examination Transesophageal echocardiography provides an excellent diagnostic and monitoring tool for anesthesiologists in the operating room. The TEE examination can be broken down into complete/ comprehensive and abbreviated forms; the user may select either depending on the urgency of the situation and other clinical responsibilities. As with any invasive procedure, the potential risks and benefits of TEE should be discussed with the patient and preoperative informed consent obtained. A study by researchers at Brigham and Women’s Hospital, in Boston, retrospectively reviewed more than 7,000 TEE examinations and found rates of procedure-related morbidity and mortality of 0.2% and 0%, respectively. Although rare, the most common TEE-related injuries were odynophagia, dental trauma, malpositioning of the endotracheal tube, upper gastrointestinal hemorrhage, and esophageal perforation. Few contraindications exist to insertion of the TEE probe; these include dysphagia, odynophagia, significant reflux, hematemesis, history of gastric and/or esophageal pathology (a hiatal hernia is not a contraindication but may complicate imaging), and significant resistance during insertion or advancement of the probe (Table 1). By