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Transesophageal echocardiography (TEE) is remarkably efficient and effective in revealing a wide spectrum of new findings and information during periods of hemodynamic instability. Since TEE technology is now readily accessible in most settings, TEE is increasingly used during noncardiac surgical procedures. However, in contrast to the cardiac surgery setting, little evidence supports the routine use of TEE in noncardiac surgery. This is largely due to the fact that the validated indications for intraoperative TEE are for use as a diagnostic tool, and not a monitor (Table 21–1). The majority of established indications in cardiac surgery directly pertain to the planned surgical procedure, or the assessment of relevant anatomical structures. To date, no large randomized trials have assessed the impact of intraoperative TEE on outcome in noncardiac surgery. Several reviews, however, have debated the use of TEE in noncardiac surgery.1–8

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Table 21–1. Recommendations for the Use of TEE in the Perioperative Period.
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Life-threatening intraoperative hemodynamic collapse is an indication for the use of TEE (ASA/SCA guidelines).9 TEE in this setting could rapidly identify abnormalities and help in establishing a diagnosis, monitor the response to treatment, and may have some prognostic value.

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The etiology of precipitating events may be difficult to diagnose, since these are often only transiently manifested. Nevertheless, TEE can be useful in diagnosing the majority of specific cardiovascular abnormalities associated ...

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