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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2015 Maggio;81(5):490-6
Focused intraoperative transthoracic echocardiography by anesthesiologists: a feasibility study
Kratz T. 1, 2, Campo Dell’Orto M. 3, Exner M. 1, Timmesfeld N. 4, Zoremba M. 1, Wulf H. 1, Steinfeldt T. 1 ✉
1 Department of Anaesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany;
2 Department of Anesthesia and Intensive Care Medicine, Clinique Bénigne Joly, Talant, France; 3 Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany;
4 Institute of Medical Biometry and Epidemiology, Philipps-University of Marburg, Marburg, Germany
BACKGROUND: Focused transthoracic echocardiography (TTE) is frequently used perioperatively for hemodynamic monitoring and diagnosis of cardiovascular instability, but less commonly intraoperatively.
METHODS: 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.
RESULTS: 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%).
CONCLUSION: TTE can be applied in the operating theatre during surgery, although its use during abdominal surgery is somewhat limited.