Perioperative transoesophageal echocardiography in noncardiac surgery

Transoesophageal echocardiography (TOE) is a semi invasive technique that allows a real time evaluation of cardiac anatomy, regional and global function. Its use is becoming an irreplaceable tool for the assessment and therapeutic management of critical patients in the Perioperative setting. A systematic search for reports describing indications for intraoperative TOE monitoring was carried out. Search terms were Perioperative TEE/TOE, intraoperative monitoring, TEE/TOE and vascular surgery, neurosurgery, orthopaedic surgery, transplant surgery. In several surgical specialties, including vascular surgery, neurosurgery, laparoscopic, orthopaedic, and transplant surgery, the intraoperative TOE monitoring found specific indications. The early recognition of haemodynamic changes, pulmonary and paradoxical embolism and ischaemic events, often not diagnosed through standard monitoring such as electrocardiography and pulmonary artery catheterization, allows a prompt therapeutic intervention and a reduction in mortality and morbidity in patients with a failing cardiac function. This paper is a review of the current uses of TOE in noncardiac surgery such as vascular surgery, neurosurgery, laparoscopic, orthopaedic, and transplant surgery. In these situations, significant haemodynamic instabilities are known to occur, which require rapid identification and solutions. TOE may have prominent role in perioperative monitoring in several noncardiac surgical procedures.