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Aoki Y, Tamura T, Uchida W, Morioka H, Yamamoto M, Yuhara S, Nishio N, Mutsuga M, Furune S, Suzuki S, Nishiwaki K. Hypopharyngeal Injury by Transesophageal Echocardiography During Cardiac Surgery. J Cardiothorac Vasc Anesth 2023; 37:2027-2031. [PMID: 37407327 DOI: 10.1053/j.jvca.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Yohei Aoki
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Tamura
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Wataru Uchida
- Department of Cardiac Surgery, Toyota Memorial Hospital, Toyota, Japan
| | - Hiroshi Morioka
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan
| | - Mayumi Yamamoto
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Yuhara
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Mutsuga
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan
| | - Satoshi Furune
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shogo Suzuki
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kimitoshi Nishiwaki
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Gangwani MK, Aziz A, Dahiya DS, Awan RU, Aziz M, Rani A, Sohail AH, Hakmi H, Ali H, Hayat U, Lee-Smith W, Kamal F, Inamdar S. Transesophageal echocardiography-associated gastrointestinal injuries: systematic review and pooled rates of gastrointestinal injuries. Proc AMIA Symp 2023; 36:729-733. [PMID: 37829235 PMCID: PMC10566391 DOI: 10.1080/08998280.2023.2243381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/25/2023] [Indexed: 10/14/2023] Open
Abstract
Upper gastrointestinal (GI) injuries are associated with transesophageal echocardiography (TEE) complications. We reviewed rates and various types of complications with GI injuries. A comprehensive literature search using five databases was conducted. Pooled rates were calculated for overall injuries, pooled GI complications, lacerations, and perforations with a 95% confidence interval (CI). A total of 26 studies involving 55,319 patients met inclusion criteria. The overall rate of adverse events was 0.51% (95% CI 0.3% to 0.7%). Bleeding was the most commonly reported adverse event, followed by dysphagia and lacerations. The highest rate of adverse events was observed in liver transplant patients (1.35%), followed by critically ill patients in the intensive care unit (1.1%), hospitalized patients (1.1%), patients undergoing intraoperative TEE (0.7%), and those undergoing cardiac procedures (0.67%). The pooled complication rate for bleeding was 0.17% (95% CI 0.1% to 0.3%), while odynophagia/dysphagia had a rate of 0.27% (95% CI -0.1% to 0.5%) and lacerations had a rate of 0.12% (95% CI -0.1% to 0.5%). A subgroup analysis comparing variceal and nonvariceal cohorts from three studies showed no significant difference in bleeding rates. Our study findings showed a low risk of esophageal injury in patients undergoing TEE.
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Affiliation(s)
| | - Abeer Aziz
- Division of Gastroenterology and Hepatology, Augusta University, Augusta, Georgia, USA
| | - Dushyant Singh Dahiya
- Department of Medicine, Central Michigan University College of Medicine, Saginaw, Michigan, USA
| | - Rehmat Ullah Awan
- Department of Medicine, Ochsner Health System, Meridian, Mississippi, USA
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Anooja Rani
- Division of Medicine, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Amir Humza Sohail
- Department of General Surgery, New York University Langone Health, Long Island, New York, USA
| | - Hazim Hakmi
- Department of General Surgery, New York University Langone Health, Long Island, New York, USA
| | - Hassam Ali
- Department of Gastroenterology and Hepatology, East Carolina University Health, Greenville, North Carolina, USA
| | - Umar Hayat
- Department of Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, Ohio, USA
| | - Faisal Kamal
- Digestive Health Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Borde D, C K, Jasapara A, Shetty V, Juvekar N, Desurkar V, Gaidu J, Joshi P, Asegaonkar B, Kp U, V V, Joshi S, Koshy T. Use of a Video Laryngoscope to Reduce Complications of Transesophageal Echocardiography Probe Insertion: A Multicenter Randomized Study. J Cardiothorac Vasc Anesth 2022; 36:4289-4295. [PMID: 36038439 DOI: 10.1053/j.jvca.2022.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/08/2022] [Accepted: 07/17/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective of this multicenter study was to test the hypothesis of whether the use of a video laryngoscope (VL) reduces complications related to transesophageal echocardiography (TEE) probe insertion. DESIGN A multicenter randomized control study. SETTING At 5 tertiary care level hospitals. PARTICIPANTS Three hundred sixty-three adult patients undergoing elective cardiac surgery. INTERVENTIONS The patients were randomized into 2 groups-the conventional group (C group; n = 177) and the VL group (n = 186) for TEE probe insertion. MEASUREMENTS AND MAIN RESULTS The primary endpoint of the study was the incidence of oropharyngeal injury, which was defined as blood at the tip of the TEE probe at the end of surgery and/or evidence of injury on VL examination at the end of surgery. The secondary endpoints of the study were the number of attempts required for successful TEE probe insertion and the relation between the esophageal inlet and the larynx. There was a higher incidence of injuries in the C group (n = 26; 14.7%) compared to the VL group (n = 14; 7.5%; p = 0.029). The number of attempts for probe insertion was significantly lower in the VL group (p = 0.0023). The most common relation between the esophageal inlet and the larynx was posterolateral (n = 88; 47%), followed by posterior (n = 77; 41%) and lateral (n = 21;12%). CONCLUSION The use of VL was associated with a lesser incidence of injury compared to the conventional technique, and its use for this purpose is recommended. The use of VL for probe insertion resulted in fewer attempts compared with the conventional technique. Significant variations do exist in the relation between the esophageal inlet and the larynx, and direct visualization with VL may contribute to better safety.
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Affiliation(s)
- Deepak Borde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India.
| | - Kumar C
- Department of Cardiac Anesthesia, Madras Medical Mission, Chennai, Tamilnadu, India
| | - Amish Jasapara
- Department of Cardiac Anesthesia, Fortis Hospitals, Mulund, Mumbai, Maharashtra, India
| | - Vijay Shetty
- Department of Cardiac Anesthesia, Fortis Hospitals, Mulund, Mumbai, Maharashtra, India
| | - Nilesh Juvekar
- Department of Cardiac Anesthesia, Deenanath Maneshkar Hospital, Pune, Maharashtra, India
| | - Vinayak Desurkar
- Department of Cardiac Anesthesia, Deenanath Maneshkar Hospital, Pune, Maharashtra, India
| | - Jyoti Gaidu
- Department of Cardiac Anesthesia, Deenanath Maneshkar Hospital, Pune, Maharashtra, India
| | - Pooja Joshi
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Balaji Asegaonkar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Unnikrihnan Kp
- Department of Cardiac Anesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Vipinraj V
- Department of Cardiac Anesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Shreedhar Joshi
- Department of Cardiac Anesthesia, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Thomas Koshy
- Department of Cardiac Anesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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Bruce SS, Navi BB, Zhang C, Kim J, Devereux RB, Schenck EJ, Sedrakyan A, Díaz I, Kamel H. Transesophageal echocardiography and risk of respiratory failure in patients who had ischemic stroke or transient ischemic attack: an IDEAL phase 4 study. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000116. [PMID: 35187480 PMCID: PMC8823208 DOI: 10.1136/bmjsit-2021-000116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Transesophageal echocardiography (TEE) is sometimes used to search for cardioembolic sources after ischemic stroke or transient ischemic attack (TIA). TEE visualizes some sources better than transthoracic echocardiography, but TEE is invasive and may cause aspiration. Few data exist on the risk of respiratory complications after TEE in patients who had stroke or TIA. Our objective was to determine whether TEE was associated with increased risk of respiratory failure in patients who had ischemic stroke or TIA. Design This is a retrospective cohort study using administrative data from inpatient and outpatient insurance claims collected by the US federal government’s Centers for Medicare and Medicaid Services. Setting Hospitals and outpatient clinics throughout the USA. Participants 99 081 patients ≥65 years old hospitalized for out-of-hospital ischemic stroke or TIA, defined by validated International Classification of Disease-9/10 diagnosis codes and present-on-admission codes, using claims data from 2008 to 2018 in a random 5% sample of Medicare beneficiaries. Main outcome measures Acute respiratory failure, defined as endotracheal intubation and/or mechanical ventilation, starting on the first day after admission through 28 days afterward. Results Of 99 081 patients included in this analysis, 73 733 (74.4%) had an ischemic stroke and 25 348 (25.6%) a TIA. TEE was performed in 4677 (4.7%) patients and intubation and/or mechanical ventilation in 1403 (1.4%) patients. The 28-day cumulative risk of respiratory failure after TEE (1.4%; 95% CI 0.8% to 2.7%) was similar to that seen in those without TEE (1.4%; 95% CI 1.4% to 1.5%) (p=0.84). After adjustment for age, sex, race, Charlson comorbidities, diagnosis of stroke versus TIA, intravenous thrombolysis, and mechanical thrombectomy, TEE was not associated with an increased risk of respiratory failure (HR, 0.9; 95% CI 0.6 to 1.2). Conclusions In a cohort of older patients who had ischemic stroke or TIA, TEE was not associated with an increased risk of subsequent respiratory failure.
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Affiliation(s)
- Samuel S Bruce
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
| | - Cenai Zhang
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
| | - Jiwon Kim
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | | | - Edward J Schenck
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Iván Díaz
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
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Patel KM, Desai RG, Trivedi K, Neuburger PJ, Krishnan S, Potestio CP. Complications of Transesophageal Echocardiography – A Review of Injuries, Risk Factors and Management. J Cardiothorac Vasc Anesth 2022; 36:3292-3302. [DOI: 10.1053/j.jvca.2022.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 01/09/2023]
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Kumamoto T, Tashima K, Hiraoka C, Ikuta Y, Yamamoto T. McGRATH MAC video laryngoscope assistance during transesophageal echocardiography may reduce the risk of complications: a manikin study. BMC Anesthesiol 2021; 21:14. [PMID: 33430768 PMCID: PMC7798285 DOI: 10.1186/s12871-020-01231-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although transesophageal echocardiography (TEE) is considered a relatively safe diagnostic monitoring method, blind probe insertion is associated with pharyngeal trauma. Through visual observation of the esophageal inlet with the McGRATH video laryngoscope, it may be possible to insert the TEE probe at an appropriate angle and prevent pharyngeal trauma. We conducted a manikin study to investigate whether the use of the McGRATH video laryngoscope for TEE probe insertion reduced the pressure on the posterior pharyngeal wall. METHODS Twenty-seven junior (inexperienced group) and 10 senior (experienced group) anesthesiologists participated in this study. The TEE probe was inserted into an airway manikin in a blind fashion (blind group) or under visualization with the McGRATH (McGRATH group) video laryngoscope (three times each). A sealed bag filled with normal saline was placed on the back of the posterior pharyngeal wall of the manikin and connected to a patient monitoring system via a pressure transducer. We measured the internal bag pressure and approximated this value to the pressure on the posterior pharyngeal wall. RESULTS The pressure on the posterior pharyngeal wall was significantly lower in the McGRATH group than in the blind group (p < 0.001) and was significantly reduced when the McGRATH was employed in both the inexperienced (p < 0.001) and experienced (p < 0.001) groups. CONCLUSIONS These findings suggest that TEE probe insertion under the assistance of the McGRATH video laryngoscope can reduce the pressure on the posterior pharyngeal wall, regardless of the clinician's experience, and may inform clinical practice with the potential to reduce probe insertion-associated complication rates.
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Affiliation(s)
- Taisuke Kumamoto
- Department of Anesthesiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, 860-8556, Kumamoto, Japan.
| | - Koichiro Tashima
- Department of Anesthesiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, 860-8556, Kumamoto, Japan
| | - Chieko Hiraoka
- Department of Anesthesiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, 860-8556, Kumamoto, Japan
| | - Yoshihiro Ikuta
- Department of Anesthesiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, 860-8556, Kumamoto, Japan
| | - Tatsuo Yamamoto
- Department of Anesthesiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, 860-8556, Kumamoto, Japan
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7
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Freitas-Ferraz AB, Bernier M, Vaillancourt R, Ugalde PA, Nicodème F, Paradis JM, Champagne J, O’Hara G, Junquera L, del Val D, Muntané-Carol G, O’Connor K, Beaudoin J, Rodés-Cabau J. Safety of Transesophageal Echocardiography to Guide Structural Cardiac Interventions. J Am Coll Cardiol 2020; 75:3164-3173. [DOI: 10.1016/j.jacc.2020.04.069] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/09/2020] [Accepted: 04/23/2020] [Indexed: 11/30/2022]
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8
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Namekawa M, Tsujimoto Y, Banno M, Kataoka Y, Tsujimoto H, Inaba Y, Fujiwara T. Videolaryngoscopy for transesophageal echocardiography probe insertion: a systematic review and meta-analysis of randomized controlled trials. J Anesth 2020; 34:453-463. [PMID: 32219541 DOI: 10.1007/s00540-020-02759-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/07/2020] [Indexed: 10/24/2022]
Abstract
Transesophageal echocardiography (TEE) is a well-established procedure, but serious complications may occur. This systematic review and meta-analysis assessed the utility of videolaryngoscopy-assisted technique in TEE probe insertion. We performed a systematic search in MEDLINE, EMBASE, CENTRAL, and ICTRP. We included RCTs comparing TEE probe insertion techniques assisted with videolaryngoscopy and with any other insertion technique in adult patients. Primary outcome measures were (1) the number of attempts before successful TEE probe insertion, and (2) the risk of any procedural injury to related structures. The secondary outcome measure was time to TEE probe insertion. In total, three studies (n = 266) were included in this systematic review. Overall, a significantly less number of attempts were required with videolaryngoscopy-assisted insertion (mean difference [MD] - 0.60; 95% confidence interval [CI] - 0.73, - 0.46; low quality of evidence). Videolaryngoscopy-assisted technique was also associated with smaller risk of complications (risk ratio [RR] 0.17; 95% CI 0.05, 0.62; low quality of evidence). There was no significant difference in time to probe insertion (MD - 8.57; 95% CI - 26.31, 9.16; very low quality of evidence). The use of videolaryngoscopy for TEE probe insertion is associated with a significant reduction in the number of attempts and complication rate.
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Affiliation(s)
- Motoki Namekawa
- Department of Critical Care Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, Japan.
| | - Yasushi Tsujimoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Nephrology and Dialysis, Kyoritsu Hospital, Hyogo, Japan
| | - Masahiro Banno
- Department of Psychiatry, Seichiryo Hospital, Nagoya, Japan.,Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuki Kataoka
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Hiraku Tsujimoto
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Yu Inaba
- Department of Obstetrics and Gynecology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takashi Fujiwara
- Department of Otolaryngology Head and Neck Surgery, Kurashiki Central Hospital, Kurashiki, Japan
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Freitas-Ferraz AB, Rodés-Cabau J, Junquera Vega L, Beaudoin J, O'Connor K, Turgeon PY, Paradis JM, Ferreira-Neto A, Asmarats L, Champagne J, O'Hara G, Bernier M. Transesophageal echocardiography complications associated with interventional cardiology procedures. Am Heart J 2020; 221:19-28. [PMID: 31896037 DOI: 10.1016/j.ahj.2019.11.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/22/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although there have been several reports documenting complications related with transesophageal echocardiography (TEE) manipulation following cardiac surgery, there is a paucity of data regarding the safety of TEE used to guide catheter-based interventions. The aim of this study was to determine the prevalence, types and risk factors of complications associated with procedures requiring active TEE guidance. METHODS This study included 1249 consecutive patients undergoing either transcatheter aortic valve implantation (TAVI), Mitraclip, left atrial appendage occlusion (LAAO) or paravalvular leak closure (PVLC). Patients were divided into 2 cohorts based on the degree of probe manipulation required to guide the procedure and the risk of developing a TEE-related complication: low-risk (TAVI, n = 1037) and high-risk (Mitraclip, LAAO and PVLC, n = 212). Patients were further analyzed according to the occurrence of major and minor TEE-related complications. RESULTS The overall incidence of TEE-related complications was 0.9% in the TAVI group and 6.1% in the rest of the cohort (P < .001). Patients in the high-risk cohort had also a higher incidence of major-complications (2.8% vs 0.6%, P = .008), and factors associated with an increased risk were being underweight, having a prior history of gastrointestinal bleeding and the use of chronic steroids/immunosuppressive medications. Procedural time under TEE-manipulation was longer in patients exhibiting complications and was an independent predictor of major complications (OR = 1.13, 95% CI 1.01-1.25, for each 10 minutes increments in imaging time). Patients with major complications undergoing Mitraclip had the longest median time under TEE-manipulation (297 minutes) and a risk of developing a major-complication that was 10.64 times higher than the rest of the cohort (95% CI 3.30-34.29, P < .001). CONCLUSION The prevalence of TEE-related complications associated with interventional procedures is higher than previously reported. Undergoing a prolonged procedure, particularly in the setting of Mitraclip, was the main factor linked to TEE-related complications.
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10
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Dieleman JM, Myles PS, Bulfone L, Younie S, van Zaane B, McGiffin D, Moodie M, Gao L. Cost-effectiveness of routine transoesophageal echocardiography during cardiac surgery: a discrete-event simulation study. Br J Anaesth 2019; 124:136-145. [PMID: 31866001 DOI: 10.1016/j.bja.2019.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/23/2019] [Accepted: 10/17/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The aim of this study was to simulate and compare the healthcare and economic outcomes associated with routine use of intraoperative transoesophageal echocardiography (TOE) in patients undergoing cardiac surgery with those associated with a scenario where TOE is not routinely used. METHODS The impact of TOE on surgical decision-making was estimated through a systematic literature review. Individual short-term morbidity and mortality estimates were generated by application of the Society of Thoracic Surgeons risk calculator. Long-term event rates, unit costs, and utility weights were sourced from published literature and expert opinion. A discrete-event simulation model was then constructed to simulate both the in-hospital and post-discharge outcomes for patients undergoing cardiac surgery. Robustness of the base case results was examined through deterministic and probabilistic sensitivity analyses. An incremental cost-effectiveness ratio of €30 000 per quality-adjusted life-year gained was assumed to represent acceptable cost-effectiveness. RESULTS Routine use of intraoperative TOE was associated with lower costs and higher benefits per patient, which indicates that use of TOE is a dominant strategy. The intervention resulted in the avoidance of 299 cardiac complications, 20 strokes, and 11 all-cause deaths per 10 000 patients. Routine intraoperative TOE was associated with an increased occurrence of bleeding owing to more valvular surgery and subsequent long-term anticoagulation. CONCLUSIONS Routine intraoperative TOE is a cost-effective procedure for patients undergoing cardiac surgery, leading to lower overall costs. It was associated with a decrease in long-term complications including stroke, cardiac complications, and death, although there was a slight increase in extracranial bleeding events.
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Affiliation(s)
- Jan M Dieleman
- Department of Anaesthesia, Westmead Hospital, Sydney, Australia; Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia.
| | - Paul S Myles
- Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia
| | - Liliana Bulfone
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, Australia
| | - Sandra Younie
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, Australia
| | - Bas van Zaane
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David McGiffin
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, Australia
| | - Lan Gao
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, Australia
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Difficult TEE Probe Placement: The Evidence, Troubleshooting Techniques, and a Guide to Alternative Monitoring Options for Intraoperative Physicians. Semin Cardiothorac Vasc Anesth 2019; 23:369-378. [DOI: 10.1177/1089253219842836] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Transesophageal echocardiography (TEE) imaging has become an essential component of many open and interventional cardiac procedures and has increasing use in monitoring for noncardiac procedures, partly because of an aging population. Whether expected or not, encountering difficulty when inserting the TEE probe presents the anesthesiologist with a conundrum. Repeated insertion attempts increase the risk of a serious complication; however, proceeding without TEE may be unacceptable to the proceduralist or surgeon. The aim of this review is to present the spectrum of complications possible with TEE, propose several evidence-based insertion tips, examine potential alternative cardiac imaging options, and finally, propose a roadmap for providers who encounter difficulty when placing a TEE probe.
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Purza R, Wąsowicz M, Moreno Garijo J. Esophageal Perforation After Transesophageal Echocardiography During Cardiac Surgery and Delayed Diagnosis. J Cardiothorac Vasc Anesth 2018; 33:587-588. [PMID: 30297260 DOI: 10.1053/j.jvca.2018.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Razvan Purza
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Marcin Wąsowicz
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
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13
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Transesophageal Echocardiography Complications in Adult Cardiac Surgery: A Retrospective Cohort Study. Ann Thorac Surg 2017; 103:795-802. [DOI: 10.1016/j.athoracsur.2016.06.073] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/21/2016] [Accepted: 06/22/2016] [Indexed: 11/22/2022]
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Kavrut Ozturk N, Kavakli AS. Use of McGrath MAC Videolaryngoscope to Assist Transesophageal Echocardiography Probe Insertion in Intubated Patients. J Cardiothorac Vasc Anesth 2016; 31:191-196. [PMID: 27498268 DOI: 10.1053/j.jvca.2016.03.150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Transesophageal echocardiography (TEE) probe insertion with the conventional blind insertion technique may be difficult in anesthetized and intubated patients. The use of a videolaryngoscope may facilitate the insertion of the TEE probe. The aim of this study was to compare the conventional technique with the use of the McGrath MAC videolaryngoscope for TEE probe insertion in terms of success rate, duration of insertion, and complications in patients undergoing cardiovascular surgery. DESIGN A prospective, randomized study. SETTING Training and research hospital. PARTICIPANTS Eighty-six adult patients undergoing cardiovascular surgery were included. INTERVENTIONS Eighty-six adult patients were randomized into 2 groups: conventional group (n = 43) and McGrath videolaryngoscope group (n = 43). Success rates, duration of insertion, complications, and hemodynamic changes during insertion were recorded. MEASUREMENTS AND MAIN RESULTS The success rate of TEE probe insertion at the first attempt was higher in the McGrath videolaryngoscope group (90.5%) than in the conventional group (43.9%) (p = 0.012). The mean duration for successful insertion of the TEE probe at the first attempt was longer in the McGrath videolaryngoscope group (24 s v 11 s) (p = 0.016). The total time for successful insertion of the TEE probe was similar in both groups. Pharyngeal injuries were observed more frequently in the conventional group (17.1% v 2.4%) (p = 0.037). The rate of blood presence on the probe tip in the conventional group was higher than in the McGrath group (21.9% v 4.8%). There were no statistical differences between the 2 groups in systolic blood pressure, mean arterial pressure, diastolic blood pressure, and heart rate before and after TEE insertion. CONCLUSIONS The use of the McGrath MAC videolaryngoscope for TEE insertion in cardiovascular surgery patients increases the success rate and reduces pharyngeal injuries compared to the conventional technique. The use of the McGrath MAC videolaryngoscope for TEE insertion causes similar hemodynamic changes as in the conventional blind insertion technique.
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Affiliation(s)
- Nilgun Kavrut Ozturk
- Department of Anesthesiology and Reanimation, Antalya Education and Research Hospital, Antalya, Turkey.
| | - Ali Sait Kavakli
- Department of Anesthesiology and Reanimation, Antalya Education and Research Hospital, Antalya, Turkey
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Kyeong Kim M, Wook Park S, Sim Y, Wha Lee J. Use of a McGrath Videolaryngoscope to Assist Transesophageal Echocardiography Probe Insertion in Anesthetized Patients. J Cardiothorac Vasc Anesth 2015; 29:e16-7. [DOI: 10.1053/j.jvca.2014.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Indexed: 11/11/2022]
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Sainathan S, Andaz S. A Systematic Review of Transesophageal Echocardiography-Induced Esophageal Perforation. Echocardiography 2013; 30:977-83. [DOI: 10.1111/echo.12290] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Sandeep Sainathan
- Department of Thoracic Surgery; Bronx-Lebanon Hospital Center; Bronx; New York
| | - Shahriyour Andaz
- Department of Thoracic Surgery; South Nassau Communities Hospital; Oceanside; New York
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Royse CF, Canty DJ, Faris J, Haji DL, Veltman M, Royse A. Core review: physician-performed ultrasound: the time has come for routine use in acute care medicine. Anesth Analg 2012; 115:1007-28. [PMID: 23011559 DOI: 10.1213/ane.0b013e31826a79c1] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The use of ultrasound in the acute care specialties of anesthesiology, intensive care, emergency medicine, and surgery has evolved from discrete, office-based echocardiographic examinations to the real-time or point-of-care clinical assessment and interventions. "Goal-focused" transthoracic echocardiography is a limited scope (as compared with comprehensive examination) echocardiographic examination, performed by the treating clinician in acute care medical practice, and is aimed at addressing specific clinical concerns. In the future, the practice of surface ultrasound will be integrated into the everyday clinical practice as ultrasound-assisted examination and ultrasound-guided procedures. This evolution should start at the medical student level and be reinforced throughout specialist training. The key to making ultrasound available to every physician is through education programs designed to facilitate uptake, rather than to prevent access to this technology and education by specialist craft groups. There is evidence that diagnosis is improved with ultrasound examination, yet data showing change in management and improvement in patient outcome are few and an important area for future research.
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Affiliation(s)
- Colin F Royse
- Department of Surgery, The University of Melbourne, 245 Cardigan St., Carlton, Victoria, Australia, 3053.
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Greenhalgh DL, Patrick MR. Perioperative transoesophageal echocardiography: past, present & future. Anaesthesia 2012; 67:343-6. [DOI: 10.1111/j.1365-2044.2012.07103.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Field LC, Guldan GJ, Finley AC. Echocardiography in the Intensive Care Unit. Semin Cardiothorac Vasc Anesth 2011; 15:25-39. [DOI: 10.1177/1089253211411734] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As ultrasound technology improves and ultrasound availability increases, echocardiography utilization is growing within intensive care units. Although not replacing the often-needed comprehensive echocardiographic evaluation, limited bedside echocardiography promises to provide intensivists with enhanced diagnostic ability and improved hemodynamic understanding of individual patients. Routine and emergency echocardiography within the intensive care unit focuses on identifying and optimizing medically treatable conditions in a timely manner. Methods for such goal-directed assessments are presented.
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Affiliation(s)
- Larry C. Field
- Medical University of South Carolina, Charleston, SC,
USA,
| | | | - Alan C. Finley
- Medical University of South Carolina, Charleston, SC,
USA
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Martinez EA, Thompson DA, Errett NA, Kim GR, Bauer L, Lubomski LH, Gurses AP, Marsteller JA, Mohit B, Goeschel CA, Pronovost PJ. High Stakes and High Risk. Anesth Analg 2011; 112:1061-74. [DOI: 10.1213/ane.0b013e31820bfe8e] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Chin JH, Lee EH, Choi DK, Choi IC. A Modification of the Trans-Oesophageal Echocardiography Protocol can Reduce Post-Operative Dysphagia following Cardiac Surgery. J Int Med Res 2011; 39:96-104. [DOI: 10.1177/147323001103900112] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Use of intra-operative trans-oesophageal echocardiography (TEE) is an independent risk factor for post-operative dysphagia. This study investigated whether modifying the TEE probe-placement protocol could reduce the incidence of post-operative dysphagia. In group I ( n = 100), the TEE probe was inserted after anaesthetic induction and remained in place until the completion of surgery. In group II ( n = 100), the TEE probe was inserted after anaesthetic induction, the heart was examined, then the probe was removed. The probe was inserted again before weaning from cardiopulmonary bypass and then immediately removed after examination. The incidence of dysphagia was significantly higher in group I than in group II patients (51.1% versus 28.6%). Multivariate regression analysis showed that the length of time that the TEE probe was in the oesophagus was an independent predictor of dysphagia. Modification of the TEE protocol in this way can reduce the incidence of post-operative dysphagia in cardiac surgery patients.
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Affiliation(s)
- J-H Chin
- Department of Anaesthesiology and Pain Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - E-H Lee
- Department of Anaesthesiology and Pain Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - D-K Choi
- Department of Anaesthesiology and Pain Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - I-C Choi
- Department of Anaesthesiology and Pain Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Chakravarthy M. Iatrogenic Oropharyngeal Injury and Hemorrhage Requiring Blood Transfusions During Insertion of Transesophageal Echocardiographic Probes in Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2010; 24:1023-4. [DOI: 10.1053/j.jvca.2009.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Indexed: 11/11/2022]
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23
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Pitkin AD, Blas ML, Klodell CT, Oware A, Augoustides JG. Case 4—2010Successful Use of Transesophageal Echocardiography After Esophagogastrectomy. J Cardiothorac Vasc Anesth 2010; 24:700-5. [DOI: 10.1053/j.jvca.2010.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Indexed: 12/28/2022]
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Tagawa T, Sakuraba S, Okuda M. Pentax-AWS-assisted insertion of a transesophageal echocardiography probe. J Clin Anesth 2009; 21:73-4. [DOI: 10.1016/j.jclinane.2008.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2008] [Accepted: 08/13/2008] [Indexed: 11/28/2022]
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Piercy M, McNicol L, Dinh DT, Story DA, Smith JA. Major complications related to the use of transesophageal echocardiography in cardiac surgery. J Cardiothorac Vasc Anesth 2008; 23:62-5. [PMID: 19058977 DOI: 10.1053/j.jvca.2008.09.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the incidence of injury associated with transesophageal echocardiography (TEE injuries) in cardiac surgery. DESIGN Retrospective. SETTING University-affiliated hospitals. PARTICIPANTS Four thousand seven hundred eighty-four patients, 89% of all public hospital cardiac surgery patients in Victoria, from the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) database undergoing cardiac surgery with TEE between July 1, 2005, and June 30, 2007. Because ASCTS did not record TEE use before July 2005, it was assumed that 89% of an additional 11,719 cardiac surgery patients between July 2001 and June 2005 also had TEE. INTERVENTIONS The authors searched the ASCTS database for cardiac surgery patients who also had endoscopy and/or noncardiac surgery. The files of these patients were screened for possible esophageal or gastric tears or perforations. An expert panel determined likely TEE injuries. MEASUREMENTS AND MAIN RESULTS There were 6 TEE complications from July 1, 2005, to June 30, 2007 (13/10,000 patients). There were a further 8 TEE complications before June 30, 2005, an extrapolated overall rate of 9/10,000 TEE (95% confidence interval, 5-16/10,000). TEE complications were more frequent in patients more than 70 years old (relative risk [RR], 3.7; p = 0.03) and women (RR, 6.5; p < 0.001). Three patients with TEE injury died (2/10,000). CONCLUSIONS TEE is associated with an incidence of major injuries of about 1 per 1,000 patients, with older women having a much higher risk. TEE use in cardiac surgery should be evaluated in the light of practice guidelines and morbidity and mortality data and not considered routine.
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Affiliation(s)
- Mathew Piercy
- Department of Anesthesia and Critical Care, Goulburn Valley Health, Shepparton, Victoria, Australia.
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Hirabayashi Y, Okada O, Seo N. Airtraq laryngoscope for the insertion of a transesophageal echocardiography probe. J Cardiothorac Vasc Anesth 2007; 22:331-2. [PMID: 18375345 DOI: 10.1053/j.jvca.2007.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2007] [Indexed: 11/11/2022]
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