Airway obstruction by a transesophageal echocardiography probe in an adult patient with a dissecting aneurysm of the ascending aorta and arch

Airway Obstruction by Transesophageal Echocardiography: Is Oblivion Bliss?

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Severe complications from TEE imaging are uncommon.

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Airway compression from TEE occurs in children and as rare case reports in adults.

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This can be caused by an anteflexed probe in an adult with tracheobronchomalacia.

Increased tracheal cuff pressure during insertion of a transoesophageal echocardiography probe: A prospective, observational study

BACKGROUND

Excessive tracheal cuff pressure reduces tracheal mucosal blood flow and increases tracheal morbidity. Inserting a transoesophageal echocardiography (TOE) probe has been shown to increase tracheal cuff pressure.

OBJECTIVE

To evaluate the effect of inserting a TOE probe on tracheal cuff pressure and compare the effect in patients who received a single-lumen endotracheal tube (SLT) with those who received a double-lumen endotracheal tube (DLT).

DESIGN

A prospective, observational study.

SETTING

Single-centre trial, study period from October 2013 to January 2014.

PATIENTS

Forty-four adult patients scheduled for elective cardiothoracic surgery requiring intraoperative TOE monitoring.

INTERVENTIONS

After tracheal intubation with a SLT (n = 22) or DLT (n = 22), the tracheal cuff was inflated to 18 mmHg (25 cmH2O) with air. Tracheal cuff pressure was monitored continuously for 5 min after inserting the TOE probe.

MAIN OUTCOME MEASURES

The primary endpoint was steady-state tracheal cuff pressure after insertion of the TOE probe.

RESULTS

Median (interquartile range, IQR) tracheal cuff pressure stabilised at 3 (2 to 3) min in the SLT group and at 2 (1 to 3) min in the DLT group. Steady-state cuff pressure was significantly higher in the DLT group than that in the SLT group [36.7 (31.3 to 44.1) vs. 31.3 (29.6 to 35.7) cmH2O; (P = 0.03)]. Steady-state cuff pressure more than 40 cmH2O was observed in two patients (18.2%) in the SLT group and nine patients (40.9%) in the DLT group (P = 0.02).

CONCLUSION

Insertion of a TOE probe increased tracheal cuff pressure in both the SLT and DLT groups. The increase in cuff pressure was greater in patients who received a DLT. Frequent measurement and adjustment of cuff pressure should be emphasised particularly when TOE is used in patients receiving a DLT.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT02034643.

Safety of transesophageal echocardiography

Since its introduction into the operating room in the early 1980s, transesophageal echocardiography (TEE) has gained widespread use during cardiac, major vascular, and transplantation surgery, as well as in emergency and intensive care medicine. Moreover, TEE has become an invaluable diagnostic tool for the management of patients with cardiovascular disease in a nonoperative setting. In comparison with other diagnostic modalities, TEE is relatively safe and noninvasive. However, the insertion and manipulation of the ultrasound probe can cause oropharyngeal, esophageal, or gastric trauma. Here, the authors review the safety profile of TEE by identifying complications and propose a set of relative and absolute contraindications to probe placement. In addition, alternative echocardiographic modalities (e.g., epicardial echocardiography) that may be considered when TEE probe placement is contraindicated or not feasible are discussed.

Airway obstruction after extubation following use of transesophageal echocardiography for posterior fossa surgery in the sitting position

We report respiratory obstruction following surgery in the sitting position with tracheal intubation and placement of a transesophageal echocardiography probe. Obstruction was due to pharyngeal oedema, which resolved with 24 hours. The mechanisms of this complication are discussed.

Airway obstruction associated with transesophageal echocardiography in a patient with a giant aortic pseudoaneurysm

IMPLICATIONS

Airway compression from insertion of a transesophageal echocardiography (TEE) probe has been mostly limited to pediatric patients. We present a case of TEE-associated airway obstruction in an adult patient undergoing surgery for repair of a giant ascending aortic pseudoaneurysm.

The role of transoesophageal echocardiography for anaesthetists

Transoesophageal echocardiography has proved to be a valuable monitor of global and regional ventricular function in the perioperative period. In addition, it is increasingly used by anaesthetists as a diagnostic tool in patients with heart disease. During the past year, important steps towards quality assurance and the standardization of perioperative echocardiography were undertaken, and our understanding of the perioperative cardiovascular structure and function improved.