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Intraoperative Echokardiographie

Einfluss auf das chirurgische Management

Intraoperative echocardiography

Impact on surgical decision-making

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Zusammenfassung

Seit der Einführung der intraoperativen Echokardiographie in die Klinik Mitte der 1970er Jahre sind deren Anwendung und Nutzen im perioperativen Bereich stetig gewachsen. Die intraoperative Echokardiographie spielt vor allem bei herzchirurgischen Patienten eine bedeutende Rolle. Hier stehen dem Untersucher mit der transösophagealen Echokardiographie (TEE) und der epiaortalen Sonographie (EUS) zwei wichtige diagnostische Untersuchungstechniken zur Verfügung. Mit der intraoperativen TEE können Befunde erhobenen werden, die Einfluss auf das chirurgische Management haben und somit das Outcome eines Patienten beeinflussen können. Aber auch bei nichtkardiochirurgischen Patienten kann der Einsatz der TEE sinnvoll sein und zu einer Verbesserung des intraoperativen Managements bei Hochrisikopatienten beitragen. Zudem kann die TEE bei Patienten, die intraoperativ hämodynamisch instabil werden oder kardiopulmonal reanimiert werden müssen, zur Klärung der Ursache beitragen. Durch den in der TEE erhobenen Befund kann so möglicherweise eine weiterführende Therapie veranlasst werden. Ein Vorteil der TEE ist hierbei, dass diese ohne Unterbrechung der chirurgischen Versorgung des Patienten durchgeführt werden kann.

Abstract

Since the introduction of intraoperative echocardiography into clinical practice in the 1970’s its use and utility in the perioperative period has become increasingly more evident. Especially in patients undergoing cardiac surgical procedures intraoperative echocardiography has gained great diagnostic importance. Intraoperative transesophageal echocardiography (TEE) and epiaortic ultrasound are two important and complementing diagnostic modalities in this patient population. The clinical information obtained with intraoperative TEE in certain cases might have a direct impact on surgical decision-making and therefore may positively influence patient outcome. In patients undergoing non-cardiac surgical procedures, TEE can be a valuable tool in high-risk patients, in patients experiencing hemodynamic instability or in those suffering intraoperative cardiac arrest. Intraoperative TEE might allow a primary diagnosis of the underlying etiology and facilitate the institution of further therapeutic interventions. In addition TEE can be performed during ongoing cardiopulmonary resuscitation and does not interfere with patient management. This review introduces the clinician to the current evidence of the impact of intraoperative echocardiography on intraoperative surgical decisions during surgical procedures. It helps the clinician to identify indications and realize the potential applications of intraoperative echocardiography.

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  1. Universitätsklinik für Anaesthesiologie und Intensivmedizin, Eberhard-Karls-Universität, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland

    E. Schmid, K. Unertl &  P. Rosenberger

  2. Department of Anesthesiology and Perioperative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA

    M. Nowak

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  1. E. Schmid
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  4. P. Rosenberger
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Correspondence to P. Rosenberger.

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Schmid, E., Nowak, M., Unertl, K. et al. Intraoperative Echokardiographie. Anaesthesist 58, 1123–1135 (2009). https://doi.org/10.1007/s00101-009-1620-2

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