Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000500004
Brazilian Journal of Anesthesiology
Scientific Article

Ecocardiografia transesofágica em anestesiologia: caracterização do perfil de uso em um hospital terciário

Transesophageal echocardiography in anesthesiology: characterization of use profile in a tertiary hospital

Alexander Alves da Silva; Arthur Segurado; Pedro Paulo Kimachi; Enis Donizete Silva; Fernando Goehler; Fabio Gregory; Claudia Simões

http://dx.doi.org/10.1590/S0034-70942012000500004 Braz J Anesthesiol, vol.62, n5, p.644-653, 2012
PDF Português
PDF English
Downloads: 0
Views: 1036

Resumo

JUSTIFICATIVA E OBJETIVO: Desde sua introdução, na década de 1980, a ecocardiografia transesofágica (ETE) não só ganhou popularidade como também passou por grandes avanços tecnológicos e atualmente constitui-se numa ferramenta extremamente valiosa no período intraoperatório. No Brasil ainda não há dados publicados sobre o perfil de seu uso no período intraoperatório por anestesiologistas. O objetivo deste trabalho foi descrever o perfil de uso da ETE no intraoperatório por Serviço de Anestesiologia em um hospital privado de nível terciário. PACIENTES E MÉTODOS: Estudo retrospectivo feito através da coleta de dados das fichas preenchidas em todos os casos em que o paciente foi monitorado com a ETE. A monitoração foi aplicada nos pacientes enquadrados nas classes I e II de acordo com a Sociedade Americana de Ecocardiografia e que não apresentassem contraindicação ao exame. No fim do procedimento, após a conclusão do exame, uma anotação na ficha classificou a monitoração quanto à sua utilidade no período intraoperatório em três grupos: grupo 1 - a ETE não interferiu na conduta cirúrgica ou anestésica; grupo 2 - a ETE motivou mudança na conduta anestésica quanto à administração de volume, introdução e/ou modificação de drogas vasoativas (aqui a ETE gerou a mudança de conduta anestésica em conjunto com os outros monitores, porém sendo ela o fator decisivo); grupo 3 - a ETE levou a mudança de conduta ou revisão do procedimento cirúrgico. RESULTADOS: De janeiro de 2009 a janeiro de 2011, 164 ETE intraoperatórias foram feitas em nosso serviço, sendo 41 pacientes pediátricos e 123 adultos. Em todos os pacientes o exame foi feito com sucesso e não houve problemas com relação à introdução da sonda transesofágica. No grupo dos pacientes pediátricos, 10 ficaram no grupo 1 (24,4%), 27 no grupo 2 (65,8%) e quatro no grupo 3 (9,8%). Entre os adultos, o grupo 1 ficou com 38 pacientes (30,9%), o grupo 2 com 81 (65,9%) e o grupo 3 com 4 (3,2%). CONCLUSÕES: Apesar da pequena casuística quando comparada à literatura mundial e das limitações deste estudo, houve concordância com outros relatos com relação às mudanças de conduta cirúrgico-anestésica baseadas na ETE intraoperatória. Os dados também sugerem fortemente que a ecocardiografia transesofágica constitui-se em ferramenta extremamente útil para a monitoração de pacientes de alto risco cardiovascular, mesmo quando submetidos a cirurgia não cardíaca. Maiores estudos originados no nosso país são necessários, pois não há na literatura outros trabalhos que definam o perfil de uso ou mesmo que estabeleçam claramente como vem sendo usada a ETE em nosso meio.

Palavras-chave

ANESTESIA, Geral, Especialidade, Registro, ANESTESIOLOGIA, Pesquisa, Segurança, CUIDADOS, Intraoperatório, MONITORAÇÃO, Ecocardiografia Transesofágica

Abstract

BACKGROUND AND OBJECTIVE: Since its introduction in the 80s, transesophageal echocardiography (TEE) not only gained popularity but also experienced great advances in technology and currently it is an extremely valuable tool in the intraoperative period. In Brazil, there are no published data on the profile of its use in the intraoperative period by anesthesiologists. The objective of this study was to describe the use of intraoperative TEE in an Anesthesiology Service in a tertiary private hospital. PATIENTS AND METHODS: Retrospective study from completed medical charts in all cases where the patient was monitored with TEE. Monitoring was applied in patients classified as I-II according to the American Society of Echocardiography and presenting no contraindication to the examination. At the end of procedure, after examination, a note on the chart classified monitoring according to its usefulness in the intraoperative period into three groups: group 1, no interference of TEE in anesthetic or surgical approach; group 2, TEE prompted change in anesthetic approach regarding the administration of volume, introduction and/or modification of vasoactive drugs (here, TEE generated change of anesthetic approach in conjunction with other monitors, but it was the deciding factor); group 3, TEE led to a change in approach or review of surgical procedure performed. RESULTS: From January 2009 to January 2011, 164 intraoperative TEE were performed in our service, with 41 pediatric and 123 adult patients. In all patients, the test was successful and there were no problems regarding the introduction of transesophageal tube. In pediatric sample, group I had 10 patients (24.4%), group II had 27 patients (65.8%), and group III had 4 patients (9.8%). Among adults, group I had 38 patients (30.9%), group II had 81 patients (65.9%), and group III had 4 patients (3.2%). CONCLUSION: Despite this small sample size compared to the literature, and the limitations of this study, there was agreement with other reports related to changes in anesthetic-surgical approach based on intraoperative TEE. Our data also strongly suggest that transesophageal echocardiography is an extremely useful tool for monitoring patients at high cardiovascular risk, even when undergoing noncardiac surgery. Larger studies conducted in our country are needed, as there are no other studies in literature defining the use profile of TEE or even clearly setting out how it has been used in our field.

Keywords

Monitoring, Intraoperative, Echocardiography, Transesophageal, Anesthesia, General, Data Collection, Perioperative Period

References

Denault A, Couture P, McKenty S. Perioperative use of transesophageal echocardiography by anesthesiologists: Impact in non-cardiac surgery and in the intensive care unit. Can J Anasth. 2002;49:287-294.

Kolev N, Brase R, Swanevelder J. European Perioperative TOE Research Group: The influence of transesophageal echocardiography on intraoperative decision making. A European multicentre study. Anaesthesia. 1998;53:767-773.

Morewood GH, Gallagher ME, Gaughan JP. Current practice patterns for adult perioperative transesophageal echocardiography in the United States. Anesthesiology. 2001;95:1507-1512.

Ramamoorthy C, Lynn AM, Stevenson JG. Pro: Transesophageal echocardiography should be routinely used during pediatric open cardiac surgery. J Cardiothorac Vasc Anesth. 1999;13:629-631.

Qaddoura FE, Abel MD, Mecklenburg KL. Role of intraoperative transesophageal echocardiography in patients having coronary artery bypass graft surgery. Ann Thorac Surg. 2004;78:1586-1590.

Hofer C, Zollinger A, Rak M. Therapeutic impact of intraoperative transesophageal echocardiography during noncardiac surgery. Anaesthesia. 2004;59:3-9.

Suriani RJ, Neustein S, Shore-Lesserson L. Intraoperative transesophageal echocardiography during noncardiac surgery. J Cardiothorac Vasc Anesth. 1998;12:274-280.

Shanewise J, Cheung A, Aronson S. Practice guidelines for perioperative transesophageal echocardiography. Anesthesiology. 1996;84:986-1006.

Vieillard-Baron A, Chergui K, Rabiller A. Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients. Intensive Care Med. 2004;30(9):1734-9.

Feissel M, Michard F, Mangin I, Ruyer O, Faller JP, Teboul JL. Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest. 2001;119:867-873.

Bettex DA, Prêtre R, Jenni R, Schmid ER. Cost-Effectiveness of Routine Intraoperative Transesophageal Echocardiography in Pediatric Cardiac Surgery: A 10-Year Experience. Anesth Analg. 2005;100:1271-1275.

Stevenson JG. Adherence to physician training guidelines for pediatric transesophageal echocardiography affects the outcome of patients undergoing repair of congenital cardiac defects. J Am Soc Echocardiogr. 1999;12:165-172.

Roberson DA, Muhiudeen IA, Cahalan MK. Intraoperative transesophageal echocardiography of ventricular septal defect. Echocardiography. 1991;8:687-697.

Jneid H, Bolli R. Inotrope use at separation from cardiopulmonary bypass and the role of pre bypass TEE. J Cardiothorac Vasc Anesth. 2004;8:401-403.

Hillel Z. Refining intraoperative echocardiography. J Cardiothorac Vasc Anesth. 2003;17:419-421.

Thys DM. Echocardiography and anesthesiology successes and challenges. Anesthesiology. 2001;95:1313-1314.

Fanshawe M, Ellis C, Habib S, Konstadt SN, Reich DL. A Retrospective Analysis of the Costs and Benefits Related to Alterations in Cardiac Surgery from Routine Intraoperative Transesophageal Echocardiography. Anesth Analg. 2002;95:824-827.

Qaddoura FE, Abel MD, Mecklenburg KL. Role of Intraoperative Transesophageal Echocardiography in Patients Having Coronary Artery Bypass Graft Surgery. Ann Thorac Surg. 2004;78:1586-1590.

Schulmeyer MCC, Santelices E, Vega R, Schmied S. Impact of Intraoperative Transesophageal Echocardiography During Noncardiac Surgery. J Cardioth Vasc Anest. 2006;20(6):768-771.

Denault A, Couture P, McKenty S. Perioperative use of transesophageal echocardiography by anesthesiologists: Impact in noncardiac surgery and in the intensive care unit. Can J Anesth. 2002;49:287-294.

Patteril M, Swaminathan M. Pro: Intraoperative transesophageal echocardiography is of utility in patients at high risk of adverse cardiac events undergoing noncardiac surgery. J Cardiothorac Vasc Anesth. 2004;18:107-109.

Miller JP, Lambert AS, Shapiro WA. The adequacy of basic intraoperative transesophageal echocardiography performed by experienced anesthesiologists. Anesth Analg. 2001;92:1103-1110.

5dd29c150e8825cd47c63493 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections