A day of TEE
TEE Rotation
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Ultrasonography, and transesophageal echocardiography (TEE) in particular, have in recent years become essential components of anesthesiology practice. Even for patients not undergoing cardiac surgery, perioperative TEE can be very useful to help monitor volume status, preload, contractility, and wall motion abnormalities. Not every anesthesiology resident has the time, interest, or resources to complete a cardiothoracic anesthesiology fellowship and achieve advanced TEE certification. Fortunately, at UVA we have a unique required TEE rotation during the CA2 year, with additional elective training available during the CA3 year, for residents to become proficient and comfortable with basic perioperative TEE. It is even possible for the motivated resident to achieve TEE testamur status during residency. Here is an account of a recent Monday on the TEE rotation. |
Katie Black, CA3
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A day of TEE
It’s 6:15 on Monday morning, and as I head into the preop holding area searching for the cardiac patients, I know it’s going to be a busy day. There are three first-start heart cases today, two CABGs and one AVR/CABG, with an additional two cardiac cases to follow. After each patient has been evaluated by the primary anesthesiologist on the case, I help place monitors on each patient as well as perform the arterial line while the primary resident focuses on placing the MAC and PAC. Placement of our invasive monitors is complete and it’s time to head back to the operating room. We bring the AVR patient into room 2001 and help transfer him to the operating room table. He has severe aortic stenosis with three-vessel disease, so induction must be undertaken with great caution. Induction and intubation are safely completed, and now it’s time to place the TEE probe and start my exam. After I complete my exam, it’s time to page cardiology for a formal intraoperative reading. I then head next door to place the TEE probe for the CABG patient in room 2002. She unfortunately has tight left main disease and very poor cardiac function with an ejection fraction of 25%, so echocardiography will be very valuable in guiding our anesthetic management. Fortunately, the third cardiac case in room 2003 is just a two-vessel CABG on a patient with preserved myocardial function, so an echo will not be needed.
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As I work my way between the cardiac rooms and give some breaks to my fellow residents, I notice that it is nearly 11:00 already and it’s time to go to echo conference. Echo conference is held each morning and consists of an attending cardiologist who reads not only intraop echos for our surgical patients, but also TTEs and stress tests for other patients in the hospital. When conference is complete, I head back to the preop holding area. The next two cardiac patients have been called for and are ready to be evaluated and lined up. When the lines are complete, I head back to operating room to give lunch breaks to the residents in the cardiac rooms. I then grab a quick bite to eat myself before the next cases get started. My initial feeling from this morning was right…it’s a busy day! |
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The remaining cardiac cases are underway and both rooms are on pump. Now is a great time to grab a coffee and review some echo material provided to us in our anesthesia library. I also try to help out my fellow residents by seeing their inpatient preops for the cardiac cases tomorrow.
At 3:30 I head back to the ORs. Both cases have just come off pump and it’s time to do a follow-up exam. As the cases end, I help transfer the patients to the cardiac post-op unit.
It’s now 5:00 and time for anesthesia TEE conference. This is a one-hour elective conference held every other Monday, where a resident presents an interesting case to fellow residents and cardiac attending. I will be discussing aortic stenosis and will present the exam I took earlier this morning on our AVR patient. My attending will also be presenting some slides on additional aortic pathology. It’s now time to go home and read up on our patients for tomorrow. It looks like it’s going to be another busy day!
