TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE)

 

Transesophageal Echocardiography (TEE) is an advanced form of echocardiography, which is a diagnostic test used to visualize the heart and its functioning. Unlike standard echocardiography, which is performed externally by placing an ultrasound probe on the chest, TEE involves the insertion of a specialized probe into the esophagus. This approach offers a closer and more detailed view of the heart, as the esophagus is located directly behind the heart.

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Here are some key points about TEE:

1. Procedure: During a TEE, the patient is usually given a sedative and a local anesthetic to numb the throat. A flexible probe with an ultrasound device at its tip is then gently guided down the throat into the esophagus. The probe emits sound waves that create detailed images of the heart's structure and function.

2. Uses: TEE is particularly useful for assessing certain heart conditions more accurately than standard echocardiography. These include problems with the heart valves, detection of blood clots or masses inside the heart, assessment of the severity of certain heart diseases, and evaluation of the heart's function in patients with a thick chest wall or lung diseases.

3. Advantages: The primary advantage of TEE over traditional echocardiography is its ability to produce clearer, more detailed images of the heart. This is because the ultrasound waves don't have to pass through skin, bones, or other tissues, which can obscure the view in standard echocardiography.

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TEE is an invaluable tool in cardiology, offering critical insights into heart health, particularly in complex cases where other diagnostic methods might not provide sufficient detail.

                                                                                                 

                                      Anesthetic Implications for Transesophageal Echocardiography (TEE)

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Anesthesia type: MAC, TIVA

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Airway: Natural airway

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Preoperative:

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• TEE provides beat to beat cardiac assessment 

• Lidocaine 4% spray into the back of oropharynx may be administered (gargle for 10 seconds)

• Patients may have poor cardiac function

• Have cardiac meds and emergency airway available

• Assess reason for TEE and ejection fraction (EF)

• Patients may haver atrial fibrillation and cardiologist want to check for thrombi

• The left atrial appendage is the most common place for clot formation

• Assess for history of esophageal varices (may cause bleeding)

• Ketamine is adventitious in patients with critically low ejection fraction

• Dentures must be removed

• Bite block is placed for TEE probe before induction

• Chin lift and jaw thrust facilitates the insertion of TEE probe (this is the most stimulating part)

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Intraoperative:

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• Hypoventilation can worsen right heart function

• If the patient obstructs, manipulate airway (chin lift, jaw thrust) to ventilate

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Postoperative:

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• Wait for patient to follow commands and open his/her mouth before removing bite block device

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Complications:

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• Throat irritation

• Esophageal injury/perforation

• Pharyngeal or laryngeal trauma

• Teeth damage

• Hypotension

• Cardiac arrest

• Submucosal hematoma

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Sources:

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Elisha, S. (2010). Case Studies in Nurse Anesthesia.

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Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

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Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

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Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

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