Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942010000500007
Brazilian Journal of Anesthesiology
Scientific Article

Utilidade da ecocardiografia transeofageana durante hipotensão arterial grave em cirurgia não cardíaca

Utility of transesophageal echocardiography during severe hypotension in non-cardiac surgery

Cabrera Schulmeyer; Jorge Farías; Eduardo Rajdl; Jaime de La Maza; Marcela Labbé

http://dx.doi.org/10.1590/S0034-70942010000500007 Braz J Anesthesiol, vol.60, n5, p.513-521, 2010
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Resumo

JUSTIFICATIVA E OBJETIVOS: Hipotensão arterial grave e refratária é uma ocorrência perioperatória rara em cirurgias não cardíacas, mas a determinação de sua etiologia é essencial para o tratamento bem-sucedido. MÉTODOS: Adultos submetidos a cirurgias não cardíacas foram incluídos prospectivamente neste estudo. Hipotensão arterial grave foi definida como uma queda de 30% em relação à pressão arterial sistólica basal que não respondeu à administração adequada de fluidos e efedrina, de acordo com critérios do anestesiologista. Uma sonda multiplanar de ecocardiografia transesofageana (ETE) foi inserida antes de qualquer outro monitoramento hemodinâmico invasivo. RESULTADOS: Quarenta e dois adultos (68 ± 12 anos) foram incluídos neste estudo, 84% durante a cirurgia não cardíaca eletiva. Cirurgias abdominais (abertas e laparoscópicas), torácicas e ortopédicas foram as mais frequentes. Em todos os pacientes, a ETE foi útil para a determinação da etiologia da hipotensão arterial grave. Hipovolemia foi diagnosticada em 18 pacientes (42%). Baixa fração de ejeção (FE < 30%) foi detectada em cinco casos, tendo sido tratada com sucesso pela administração de fármacos vasoativos. Obstrução dinâmica da via de saída do ventrículo esquerdo associada a movimento sistólico anterior (MAS) da válvula mitral foi diagnosticada em cinco pacientes; em outros seis, foi detectada embolia grave durante cirurgia dos quadris e joelhos. Isquemia miocárdica causando hipotensão arterial persistente foi detectada em cinco pacientes; em três pacientes, o tamponamento cardíaco foi a causa da hipotensão arterial grave. Dois pacientes morreram; ambos apresentavam isquemia miocárdica grave. CONCLUSÕES: Ecocardiografia transesofageana perioperatória foi realizada rapidamente e demonstrou ser uma técnica útil no contexto de hipotensão arterial durante cirurgia não cardíaca. O coração e os grandes vasos puderam ser observados diretamente e avaliados de modo funcional. Assim, a etiologia da hipotensão arterial grave pode ser facilmente identificada e tratada

Palavras-chave

COMPLICAÇÕES, MONITORIZAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Severe and refractory hypotension is an infrequent perioperative situation during non-cardiac surgery, but determining its etiology is essential for successful management and therapy. METHODS: Adults undergoing non-cardiac surgery were prospectively enrolled in this study. Severe hypotension was defined as a drop from 30% of baseline systolic arterial pressure unresponsive to adequate fluids administration and to ephedrine, according to the anasthesiologist criteria. A multiplanar transesophageal echocardiography (TEE) probe was inserted, prior to any other invasive hemodynamic monitor. RESULTS: Forty two adults (68 ± 12 years) were studied, 84% during elective non-cardiac surgery. Abdominal (open and laparoscopic), thoracic and orthopaedic surgeries were performed most frequently. In all patients, TEE was useful for determining the etiology of severe hypotension. Hypovolemia was diagnosed in 18 patients (42%). Low ejection fraction (EF < 30%) was detected in 5 cases and was successfully treated with vasoactive drugs. Dynamic left ventricular outflow tract obstruction, associated with systolic anterior motion of the mitral valve, was diagnosed in 5 patients; in another 6 patients severe embolism was detected during hip and knee surgery. Myocardial ischemia causing persistent hypotension was detected in 5 patients; in 3 patients, cardiac tamponade was the etiology of severe hypotension. Two patients died; both had severe myocardial ischemia. CONCLUSIONS: Perioperative TEE was performed quickly, proving to be a useful technique in the context of hypotension during non-cardiac surgery. The heart and great vessels could be observed directly and functionally evaluated. Thus, the etiology of severe hypotension could be easily determined and managed

Keywords

COMPLICATIONS, MONITORING

References

Mishra M, Chauhan R, Sharma KK. Real-time intraoperative transesophageal echocardiography: how useful? Experience of 5,016 cases. J Cardiothorac Vasc Anesth. 1998;12:625-632.

Fanshawe M, Ellis C, Habib S, Konstadt S, Reich D. A Retrospective Analysis of the Costs and Benefits Related to Alterations in Cardiac Surgery from Routine Intraoperative Transesophageal Echocardiography. Anesth Analg. 2002;95:824-827.

Hofer C, Zollinger A, Rak M. Therapeutic impact of intra-operative Transesophageal echocardiography during non-cardiac surgery. Anaesthesia. 2004;59:3-9.

Patteril M, Swaminathan M. Pro: intraoperative transesophageal echocardiography is of utility in patients at high risk of adverse cardiac events undergoing non-cardiac surgery. J Cardiothorac Vasc Anesth. 2004;18:107-109.

Practice guidelines for perioperative transesophageal echocardiography: A report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology. 1996;84:986-1006.

Practice guidelines for perioperative transesophageal echocardiography. Anesthesiology. 2010;112:1-13.

Suriani RJ, Neustein S, Shore-Lesserson L, Konstadt S. Intraoperative transesophageal echocardiography during non-cardiac surgery. J CardioThorac Vasc Anesth. 1998;12:274-280.

Couture P, Denault AY, McKenty S. Impact of routine use of intraoperative transesophageal echocardiography during cardiac surgery. Can J Anesth. 2000;47:20-26.

Reich D, Hossain S, Krol M. Predictors of hypotension alter induction of general anesthesia. Anesth Analg. 2005;101:622-628.

Monk T, Saini V, Weldon B. Anesthesic Management and one-year mortality after non-cardiac surgery. Anesth Analg. 2005;100:4-10.

Rosenberg P, Stanton S, Body S. Utility of intraoperative Transesophageal echocardiography for diagnosis of pulmonary embolism. Anesth Analg. 2004;99:12-16.

Koessler M, Fabiani R, Hamer H. The clinical relevance of embolic events detected by transesophageal echocardiography during cemented total hip artroplasty: a randomized clinical trial. Anesth Analg. 2001;92:49-55.

Fallon K, Fuller J, Monley P. Fat embolization and fatal cardiac arrest during hip artroplasty with methylmethacrylate. Can J Anaesth. 2001;48:626-629.

Luckner G, Margreiter J, Jochberger S. Systolic anterior motion of the mitral valve with left ventricular outflow tract obstruction: three cases of acute perioperative hypotension in non-cardiac surgery. Anesth Analg. 2005;100:1594-1598.

Brandt RR, Oh JK, Abel MD. Role of emergency intraoperative transesophageal echocardiography. J Am Soc Echocardiogr. 1998;11:972-977.

Denault AY, Couture P, McKenty S. Perioperative use of transesophageal echocardiography by anesthesiologists: impact in non-cardiac surgery and in the intensive care unit. Can J Anesth. 2002;40:287-293.

Kolev N, Brase R, Swanevelder J. The influence of transoesophageal echocardiography on intra-operative decision making: A European multicentre study. European Perioperative TOE Research Group. Anaesthesia. 1998;53:767-773.

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