Anaes · Cardiac anaesthesia
TOE for anaesthetists
Also known as Perioperative TOE · ASE SCA views · Intraoperative echocardiography
Exam-exhaustive perioperative TOE for anaesthetists: ASE/SCA standard views, contraindications and complications, basic versus comprehensive examination, pre- and post-CPB checklists, crisis imaging for weaning failure, air, SAM, dissection and tamponade, and integration with CPB numbers for ANZCA Final and equivalents.
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Target exams
Red flags
- Do not force a TOE probe with known oesophageal disease.
- A normal TG mid-SAX does not exclude all valve pathology.
- Failure to image the ascending aorta before cannulation can miss dissection risk findings.
- Imaging does not replace ACT gates or surgical haemostasis.
- Undocumented TOE findings that change the operation are a governance failure.
Meet the patient
After separation from CPB following mitral repair, BP is 70/40 despite noradrenaline. The surgeon asks: "Is this bleeding, or is it the repair?" The TOE probe is in. The examiner asks: "What do you look for, and in what order?"[2]
This topic rewards systematic imaging language and punishes random wanders around the heart.[1]
References7ShowHide
- [1]Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists J Am Soc Echocardiogr, 2013.PMID 23998692
- [2]Reeves ST et al. Special article: basic perioperative transesophageal echocardiography examination: a consensus statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists Anesth Analg, 2013.PMID 23966648
- [3]Daniel WG et al. Safety of transesophageal echocardiography. A multicenter survey of 10,419 examinations Circulation, 1991.PMID 1999032
- [4]Ashikhmina E et al. Risk factors and progression of systolic anterior motion after mitral valve repair J Thorac Cardiovasc Surg, 2021.PMID 32173099
- [5]Shore-Lesserson L et al. STS/SCA/AmSECT Clinical Practice Guidelines: Anticoagulation during Cardiopulmonary Bypass J Extra Corpor Technol, 2018.PMID 29559750
- [6]Pereira RM et al. Contemporary Clinical Practices in Anticoagulation Management During Cardiopulmonary Bypass: A Europe-Wide Survey Interdiscip Cardiovasc Thorac Surg, 2026.PMID 41787968
- [7]Mazer CD, Whitlock RP, Fergusson DA, et al. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery N Engl J Med, 2017.PMID 29130845