Alta utilidad de monitorización hemodinámica con ecocardiografía transesofágica intraoperatoria en cirugía ortopédica / Intraoperative hemodynamic monitoring using transesophageal echocardiography in orthopedic surgery

Background: Orthopedic surgery is commonly performed in elderly patients with higher cardiovascular surgical risk. Hemodynamic monitoring in these patients may prevent perioperative complications. Aim: To assess the usefulness of transesophageal echocargiography (TEE) for intraoperative cardiovascular monitoring during orthopedic surgery. Material and methods: Patients older than 65 years subjected to orthopedic surgery using general anesthesia and with a high cardiovascular risk were studied. Intraoperative TEE was performed to assess intravascular volume, myocardial contractility and the presence of myocardial ischemia. Results: Fifty three patients aged 72±5 years were studied. Hemodynamic stability was detected in 68 percent of patients, mainly reflected as episodes of hypovolemia. Myocardial ischemia was detected in two patients and embolic episodes in six (11 percent). Conclusions: Intraoperative TEE was useful for the hemodynamic evaluation of patients with high cardiovascular risk.

Evaluación de función diastólica intraoperatoria con ecocardiografía transesofágica: ¿es útil? / Intraoperative diastolic dysfunction as a risk factor for hemodynamic instability

Background: Diastolic function can be evaluated intraoperatively using transesoptiageal echocardiography. Aim: To study if intraoperative diastolic dysfunction is associated to a greater number of hemodynamic events during surgery and during the postoperative period. Material and methods: Patients with indication of intraoperative transesophageal echocardiography due to cardiovascular diseases were included in the study. Diastolic function was assessed measuring transmitral intraventricular filling delay and pulmonary vein now. Patients were divided, according to diastolic dysfunction, in those with derangements in relaxation, pseudonormalization and restrictive patterns. Hypertension, hypotension, ST segment depression, alterations in myocardial contractility, pulmonary congestion and postoperative oliguria were recorded. Results: Fifty eight patients aged 68± 12 years (39 males), were studied. Forty four had diastolic dysfunction. Intraoperative hypotension occurred in 82 percent of patients with diastolic dysfunction and 16 percent of patients without it. Likewise, hypotension and oliguria during the postoperative period were more common in patients with diastolic dysfunction. Conclusions: In this group of patients with cardiovascular disease, intraoperative diastolic dysfunction is a risk factor for hemodynamic instability.

Ecocardiografía transesofágica intraoperatoria: monitorización hemodinámica durante cirugía no cardíaca / Intraoperative transesophageal echocardiography: hemodynamic monitoring during non cardiac surgery

Introducción: La ecocardiografía transesofágica (ETE) puede ser de utilidad para monitorizar la hemodinamia intraoperatorio de pacientes con riesgo cardiovascular durante cirugía no cardíaca. Sin embargo sus indicaciones y utilidad clínica han sido poco estudiadas en nuestro medio. Objetivo: evaluar el uso de ETE intraoperatorio realizado por anestesiólogos durante cirugía no cardíaca. Métodos: Se monitorizó con un transductor transesofágico multiplanar a 218 pacientes (66 ± 8 años) con alto riesgo cardiovascular sometidos a cirugía no cardíaca; 61 por ciento fueron hombres. Se evaluó la utilidad de la monitorización hemodinámica con ETE en cada enfermo respecto de decidir cambios en el manejo perioperatorio dependientes de los hallazgos ecocardiográficos. Los pacientes fueron clasificados en 4 grupos: grupo 1= sin cambios en el manejo; grupo 2= cambio en manejo de volúmenes y drogas; grupo 3= cambios en el manejo postoperatorio y grupo 4= sustituto de catéter de arteria pulmonar. Resultados: En todos los casos se logró insertar el transductor y obtener visiones satisfactorias. En 96 casos (44 por ciento) hubo cambios en el aporte de volúmenes y fármacos guiados por ETE (grupo 2). En un 25 por ciento de los pacientes, por hallazgos ecocardiográficos hubo cambios postoperatorio (grupo 3). En 30 por ciento no se indicó Swan Ganz guiándose el manejo hemodinámico por la ETE (grupo 4). Conclusiones: La monitorización hemodinámica intraoperatoria con ETE realizada por anestesiólogos demostró alta utilidad, ya que implicó cambios de diagnóstico y conducta en la mayoría de pacientes monitorizados durante cirugía no cardíaca incluidos en esta serie.