Updated Practice Guidelines for Perioperative TEE

In 1996, the American Society of Anesthesiologists and the SCA published practice guidelines for perioperative TEE. Updated guidelines were published in 2010.

For the updated 2010 practice guidelines, information was obtained largely from two sources: scientific evidence and opinion-based evidence. Scientific evidence was categorized as (A) supportive, (B) suggestive, (C) equivocal, or (D) insufficient. Categories A and B were based on supporting randomized controlled trials and observational studies, respectively. Opinion-based evidence was primarily obtained from formal surveys and categorized as (A) survey results from an appointed panel of experts, (B) survey results from members of the American Society of Anesthesiologists, and (C) informal opinion (open forum testimony, letters, editorials, and Internet-based comments).

Summary of recommendations

Cardiac and thoracic aortic surgery

For adult patients without contraindications, TEE should be used in all open-heart (e.g., valvular) procedures and all thoracic aortic procedures and should be considered in CABG surgeries

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To confirm and refine the preoperative diagnosis
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To defect new or unsuspected pathology
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To adjust the anesthetic and surgical plan
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To assess the results of surgical intervention

Catheter-based procedures

For catheter-based procedures, TEE may be used.

Noncardiac surgery

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TEE may be used when the nature of the planned surgery or the patient’s known or suspected cardiovascular pathology might result in severe hemodynamic, pulmonary, or neurologic compromise.
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If equipment and expertise are available, TEE should be used when unexplained, life-threatening circulatory instability persists despite corrective therapy.

Critical care

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For critical care patients, TEE should be used when diagnostic information that is expected to alter management cannot be obtained by TTE or other modalities in a timely manner.

Contraindications to TEE

TEE may be used for patients with oral, esophageal, or gastric disease if the expected benefit outweighs the potential risk, provided that appropriate precautions are applied. These precautions may include the following: