Visually guided TEE probe insertion, making a case based on anatomic variation: A cadaveric study.

Area of Science:

• Anatomy
• Medical Imaging
• Surgical Procedures

Background:

• Upper esophageal anatomy variations are not well-documented.
• These variations may impact the success of transesophageal echocardiography (TEE) probe insertion.

Purpose of the Study:

• To evaluate variations in upper esophageal anatomy.
• To assess the impact of these variations on TEE probe insertion.

Main Methods:

• Nine cadavers were studied.
• Esophageal intubation was performed blindly and then with a video laryngoscope.
• Time and passes required for intubation were recorded.

Main Results:

• Visually guided intubation was faster (19.4s vs 30.3s) and required fewer passes (2.4 vs 5.3) than blind intubation.
• Most cadavers had the esophagus posterior and to the right of the trachea.
• Two cadavers had a side-by-side esophageal and tracheal arrangement, requiring a "pull to the side" jaw thrust maneuver.

Conclusions:

• This study is the first to describe upper esophageal anatomic variations relevant to TEE probe insertion.
• Awareness of side-by-side anatomy can improve esophageal intubation.
• A "pull to the side" technique may be more effective than the traditional "forward" jaw thrust in specific anatomic variations.