The Role of Transesophageal Echocardiography in Non-Cardiac Surgery

Abstract

Introduction: Transesophageal echocardiography (TEE) is standard in cardiac surgery but is increasingly used in non-cardiac procedures for hemodynamic instability. This review examines indications and impact.
Methods: Literature review (2010–2024) of observational studies and guidelines on TEE use during non-cardiac surgery (liver transplantation, major vascular, trauma). Outcomes: diagnosis of shock etiology, change in management, and complications.
Results: Thirty studies (n=2,450) found TEE identified new diagnoses (e.g., pulmonary embolism, hypovolemia, tamponade) in 34–58% of unexplained hypotension cases. Management changed in 52% (e.g., fluid, inotropes, surgical re-exploration). Esophageal injury occurred in 0.2% (minor). No TEE-related mortality.
Discussion: TEE provides real-time hemodynamic assessment without surgical field interference. Limited training and certification pathways for non-cardiac anesthesiologists are barriers. Focused protocols (e.g., TEE-FOCUS) are emerging.
Conclusions: Rescue TEE is a valuable tool for intraoperative shock in non-cardiac surgery when conventional monitoring is insufficient. Training programs and workflow integration are needed.