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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    0, Vol. Issue () : 332-337    https://doi.org/10.1007/s11684-012-0212-8
COMMENTARY
Emergent limited perioperative transesophageal echocardiography: should new guidelines exist for limited echocardiography training for anesthesiologists?
Yong G. Peng(), Gregory M. Janelle
Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254 JHMHSC, Gainesville, FL 32610-0254, USA
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Abstract

Bedside limited echocardiography, or focused cardiac ultrasound, continues to gain popularity in many emergency rooms, intensive care units, and operating rooms as a rapid method of assessing unstable patients. Effective monitoring of cardiovascular function in conditions like cardiac arrest or near-arrest is the crucial step to guide successful resuscitative efforts. Transesophageal echocardiography (TEE) has emerged as one of the preferred cardiac diagnostic and monitoring modalities in the intraoperative setting due to the fact that it is less invasive than many other monitors, is immediately accessible, and allows for continuous real-time monitoring of cardiac function. However, the minimum training requirements needed for the anesthesia provider to obtain the competency, knowledge, and skills for basic certification in perioperative TEE far exceed those developed for other medical specialties. We believe there is an urgent need to develop (1) practical guidelines for emergent perioperative TEE use for anesthesiologists and (2) a requisite educational curriculum to teach the basic skills necessary to aid in the diagnosis and treatment of cardiac arrest or near-arrest scenarios. The measures elucidated in this report summarize the efforts of the Department of Anesthesiology at the University of Florida in establishing the necessary steps to make this process not only practical, but accessible to all trainees. We hope that these collective efforts will provide more trainees the confidence in utilizing TEE to aid in establishing a diagnosis in critical situations.

Keywords transesophageal echocardiography      curriculum      competency training      hemodynamic instability     
Corresponding Author(s): Peng Yong G.,Email:ypeng@anest.ufl.edu   
Issue Date: 05 September 2012
 Cite this article:   
Yong G. Peng,Gregory M. Janelle. Emergent limited perioperative transesophageal echocardiography: should new guidelines exist for limited echocardiography training for anesthesiologists?[J]. Front Med, 0, (): 332-337.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-012-0212-8
https://academic.hep.com.cn/fmd/EN/Y0/V/I/332
TEE lecture series to cover the necessary curriculumTEE cases to cover the spectral essential knowledge
Fundamental ultrasound principlesNormal TEE exam
TEE machine and knobologyAssessment of volume status
Image acquisition and normal TEE examCongestive heart failure and dilated cardiomyopathy
Normal variant and artifactIschemic heart disease
Assessment of ventricular systolic function and regional wall motionIntracardiac shunt
Assessment of ventricular diastolic functionCardiac mass
Assessment of aortic valvular diseaseAortic stenosis/regurgitation
Assessment of mitral vavular diseaseMitral stenosis/regurgitation
Hemodynamic assessment and calculationTricuspid valve disease
Pericardial diseasePericardial effusion and tamponade
Systolic anterior motion of the mitral valveHypertrophic cardiomyopathy and systolic anterior motion
Assessment of aortic diseaseAortic aneurysm and dissection
EndocarditisEndocarditis
Congenital heart diseaseAdult congenital heart disease
Assessment of valvular functionProsthetic valves
Tab.1  TEE lectures and case library to cover the spectrum of knowledge
Specific circumstanceTrangastric viewMiddle esophageal viewUpper aortic viewModalities finding
HypovolemiaShort axisObliteration of LV chamber
Myocardial ischemiaShort axisTwo chamberFour chamberTwo chamberLong axisRegional wall motion abnormalityMitral regurgitation
Congestive heart failureShort axisFour chamberTwo chamberLong axisGlobal wall hypokinesis or akinesis
Pericardial effusionsShort axisTwo chamberFour chamberEcho-free space may contain thrombi, diastolic RV collapse
Pulmonary embolismShort axis focus on right side heartFour chamberRight ventricle inflow-outflowAscending aortic short axisRV overloadIntracardiac or pulmonary artery thrombi
Intracardiac shuntShort axisFour chamberCommissuralBicavalAtrial or ventricular septal defect or shunt, or fistula detect by color flow Doppler
Aortic dissectionAscending aortic long axisDescending aortic short axisLong axisAortic archIntimal flaps on multiple planesSevere aortic regurgitation, pericardial tamponade,RWMA
Unrecognized severe aortic stenosisShort axisDeep gastricAortic valve short axisLong axisCalcified stenotic aortic valveLeft ventricle hypertrophyMay accompany with regurgitation
Systolic anterior motion of MVShort axisLong axisDeep gastricFour chamberLong axisLeft ventricular hypertrophyObliteration left ventricle cavityMitral regurgitationDynamic aortic stenosis
Tab.2  Specific circumstances and TEE views to establish findings
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[1] Yong G. Peng, Haibo Song, E. Wang, Weipeng Wang, Jin Liu. Essential training steps to achieving competency in the basic intraoperative transesophageal echocardiography examination for Chinese anesthesiologists[J]. Front. Med., 2015, 9(1): 123-128.
[2] Fei Liu, Ming-chon Hsiung, Haibo Song, Ke Dian, Hong Tang, Jin Liu. Unexpected co-arctation of aorta detected by transesophageal echocardiography during patent ductus arteriosus ligation[J]. Front Med, 2013, 7(2): 270-273.
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