Focused intraoperative transthoracic echocardiography by anesthesiologists: a feasibility study

Focused transthoracic echocardiography (TTE) is frequently used perioperatively for hemodynamic monitoring and diagnosis of cardiovascular instability, but less commonly intraoperatively.

To evaluate the feasibility of intraoperative TTE, we enrolled 222 anesthetised patients from August to November 2012 into a prospective observational study. 162 patients underwent TTE examination according to the Focused Assessed Transthoracic Echocardiography (FATE) protocol after positioning and draping for surgery. Sixty additional hemodynamically unstable subjects were examined during anesthesia and surgery. The imaging quality of four FATE views was rated on a scale from 1 (impossible) to 5 (perfect). TTE was assessed as applicable, if at least two of the four basic FATE views were graded 4 or 5, or three views were assessed as grade 3.

Imaging quality was unacceptable in 20 patients, resulting in a feasibility rate of 91% (97.5%-CI 0.86-1, P=0.01). TTE was feasible in hemodynamically unstable subjects (91.7%; 97.5%-CI 0.82-1.0), in orthopedic and trauma patients (>95% respectively, [97.5%-CI 0.83-1]) and in abdominal surgery (78%).

TTE can be applied in the operating theatre during surgery, although its use during abdominal surgery is somewhat limited.