Anestesia e Pesquisa Clínica
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Enhancing Anaesthesia Care: The Vital Role of Perioperative Transthoracic Echocardiography Services

Ayya Syama Sundar1*, Ravindar Bethi2, Gopinath Ramachandran3

With the advances in medical and surgical fields, with the evolution of surgeries for more complex situations, more frail patients, often elderly with multiple comorbidities with advanced stages of incidental diseases, are more often presenting for surgeries.

Many of these patients with varying systemic comorbidities require preoperative cardiology and echocardiography evaluation as a component of preoperative assessment, risk stratification, and optimization before choosing the appropriate anaesthetic management plan and surgical approach. Frequent cardiology referrals for this task often prove to be a time-consuming and expensive process, increasing the delay in time from hospital admission to surgery and the total duration of hospital stay. Such preoperative delays indirectly increase perioperative morbidity, mortality, and patient anesthesia dissatisfaction.

To confront these hurdles, Perioperative Transthoracic Echocardiography (PTTE) services by trained anesthesiologists have gained prominence. Not only do these services offer a cost-efficient alternative, but they also expedite decisionmaking in urgent scenarios. Recent ESC guidelines also suggested Focused Cardiac Ultrasound (FoCUS) performed by trained specialists to be considered as an alternative to comprehensive echocardiography for pre-operative triage to avoid delaying surgery.

This article emphasizes the pivotal role of PTTE in perioperative care, highlighting its utility in managing hemodynamic instability, preoperative optimization, efficient utilization of health care resources and enhancing patient outcomes. It also addresses non-cardiac anesthesiologists' reluctance to embrace PTTE, primarily due to the absence of standardised training and certification.

Certification and formal PTTE training empower non-cardiac anaesthesiologists and help to incorporate echocardiography into their perioperative practices. Moreover, integrating PTTE into residency training curricula and establishing dedicated PTTE teams are essential steps in promoting its routine use. Adherence to quality assurance measures and enhancing operator performance in PTTE services significantly improve patient care and perioperative outcomes.