Intraoperative monitoring with transesophageal echocardiography: indications, risks, and training.

There are benefits and risks to the use of TEE. The benefits are derived from the physiologic information that TEE provides, which may not be as readily obtained by any other technique. The risks of TEE are those related to mechanical trauma from the probe, as well as those of an incorrect TEE interpretation by the echocardiographer. Intraoperative TEE is a powerful monitoring and diagnostic tool. Performance of TEE requires special skills. As has been discussed, training guidelines exist. As more clinical studies are published, the indications for intraoperative TEE are likely to expand. Class-I recommendations for intraoperative echocardiography have been listed. The authors have discussed some of the issues involved with each class-I indication. Performance of the TEE is not an end in itself and should not distract the anesthesiologist from the primary goal of patient care. With proper training and experience, the anesthesiologist may learn how to use TEE to improve patient care.