TEE contraindications - History of Esophageal varices, current/past throat radiation, esophageal narrowing/stricture Possible complications - Laryngeal spasm while inserting probe (keep emergency airway kit close), submucosal or esophagus trauma/hematoma, teeth damage. TEE patients will typically have low cardiac output so they are at risk for severe bradycardia and hypotension (keep emergency medication close). Induction - (Similar to EGD) Start propofol. When patient is sufficiently sedated, let the cardiologist know that the patient is ready for the TEE probe. As the surgeon advances the probe, a jaw lift may aid in the insertion if the patient is too sedated to swallow. Continue infusing/pushing propofol as needed, per patient comfort and respiratory/hemodynamic status. Typical Medication Lineup - Versed 1-2mg preoperatively, Robinul (0.1mg to decrease secretions), Fentanyl (25mcg to decrease sympathetic response to probe insertion), lidocaine IV bolus, propofol drip or bolus as needed. Consider low dose ketamine or precedex for patients needing more sedation without decreasing respiratory drive. Off-site - In most cases, these procedures will be done away from the OR. Make sure to pack emergency equipment and medications to secure the airway and handle swings in hemodynamics. Low Ejection Fraction (EF) - If patient has a particularly low EF ( less than 30), gargling numbing spray (Hurricane Spray) or viscus lidocaine can decrease coughing and decrease the need for medications that effect hemodynamics and respirations.
TEEs are typically performed in a preoperative, outpatient or inpatient setting to assess the heart with ultrasound from the position of the esophagus. By using an esophageal probe (similar to an EGD) the cardiologist can easily examine the heart structures that lie directly beside the esophagus.
Indications for TEEs - Assessment of the left atrium for a thrombus when the patient has atrial fibrillation. TEEs are also used for the assessment of heart conditions and diseases, such as: Endocarditis, valve disease, cardiomyopathy, pericardial disease, congenital heart disease, and myocardial or coronary heart disease.
