Basic perioperative transesophageal echocardiography: an education opportunity and a dilemma

Transesophageal echocardiography during cardiac arrest in orthopedic surgery patients: a report of two cases and a review of the literature

BACKGROUND

Cardiac arrest situations represent an enormous clinical challenge to the physicians involved. Research suggests that the utilization on transesophageal echocardiography (TEE) may provide important diagnostic information and allows for institution of more specific treatment, while not hampering resuscitation efforts.

CASE DESCRIPTION

In this review, we highlight the usefulness of TEE in cardiac arrest situations in the orthopedic setting, by presenting two perioperative cases. In one case, TEE was used to diagnose intraoperative pulmonary embolism and guide thrombolytic therapy. The second case highlights the use of TEE in management of hemodynamic instability in a patient with aortic stenosis.

LITERATURE REVIEW

Memtsoudis et al. showed that in 19 of 22 cardiac arrests, an underlying pathological process could be established with TEE, leading to specific interventions beyond the institution of advanced cardiac life support measures.

CLINICAL RELEVANCE

TEE can provide rapid diagnostic information guiding treatment in patients with hemodynamic compromise. The use is expanding beyond the cardiac operating theater and given the potential clinical impact consideration should be given to utilizing this valuable imaging modality in appropriate clinical situation.

Innovative transesophageal echocardiography training and competency assessment for Chinese anesthesiologists: role of transesophageal echocardiography simulation training

PURPOSE OF REVIEW

Transesophageal echocardiography (TEE) is playing an invaluable role in diagnosing and monitoring the patient's hemodynamics in both cardiac and noncardiac surgery. There have been many obstacles in TEE training.

RECENT FINDINGS

The TEE simulation provides an ideal environment for anesthesiologists to practice their echocardiography skills out of the operation room. It consists of a manikin and a dummy probe that enable the trainees to perform a hands-on operation with echocardiographic views and allow a virtual scene consisting of a three-dimensional cardiac model, probe tip and image plane be presented side by side simultaneously.

SUMMARY

The TEE simulator provides an easy comprehensive learning interface and a friendly environment without the psychological pressure and time limitation frequently experienced in the operation room. The simulator can also be used to assess and evaluate the trainees' manipulation skills, space thinking, and clinical judgment ability. TEE simulation-based training and testing can be an important part in TEE training curriculum before the trainees start their clinical training in the operation room.