Anestesia e Pesquisa Clínica
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Intraoperative Transesophageal Echocardiography: Review and Evolution

Mariana Duque and Humberto S Machado

increased frequency as well as in perioperative hemodynamic monitoring during noncardiac surgeries. Objectives: The aim of this analysis was to understand the evolution of the use of intraoperative TEE (iTEE) both in cardiac and noncardiac surgeries showing popular and challenging approaches in its use, and as a secondary goal, to understand the patterns to achieve competency. Methods: A literature review was carried out identifying relevant clinical studies published in last six years using the keywords listed below. Results: The quick acquisition of cardiac anatomy and function data give iTEE an importance in cardiac procedures that is undeniable, permitting refined diagnosis, detect unsuspected pathology, adjust both anesthetic and surgical plans and evaluate immediate surgical outcomes. Although, its use is less established in noncardiac surgery, the latest guidelines give an increasingly role for TEE in monitoring patients in high risk surgeries or in patients with several comorbidities that can compromise the hemodynamic status even in lower risk surgeries. iTEE is a multifaceted technical expertise and demonstration of competence is usually accomplished by successful conclusion of a training program and passing an examination. Restrictive factors to incorporating TEE proficiency into all anesthesia training include limited available equipment and trained operators. Conclusions: iTEE should be used as an auxiliary tool to have more comprehensive understanding of the patient's cardiovascular physiology and manage a most adequate anesthetic approach and surgical intervention. Meanwhile, it is advisable to have large systematic studies supporting its powerful value in both cardiac and noncardiac surgeries. Suitably, it is desirable an international adoption of TEE basic skills within anesthesia practice. Education is the most influential instrument to contribute in shifting the anesthesiology community’s standpoint of TEE use in daily clinical practice.