Transoesophageal Echocardiography in Anaesthesia and Intensive Care Medicine 2nd Edition PDF
38.91 MB PDF
The four years that have passed since the first edition of this textbook represent only a short period of the twenty-year history of perioperative transoesophageal echocardiography (TOE). Nevertheless, the new information obtained through research and educational activity in this field during the last four years justifies an updated second edition of this textbook. The new title of our textbook, TOE in Anaesthesia and Intensive Care Medicine, reflects the present wide deployment of TOE in cardiac and non-cardiac surgical patients as well as in non-surgical critically ill patients. The chapters from the first edition have been revised, updated or completely rewritten to incorporate the numerous new publications generated in the field of perioperative TOE.
Important developments in the field of ultrasound technology, such as three-dimensional echocardiography, contrast echocardiography, and tissue doppler imaging, have entered the practice of echocardiography during these last four years. We considered including new chapters that would comprehensively cover these techniques; however, we believe that the present impact of these methods on the practice of perioperative TOE does not yet justify extensive coverage in the present textbook. Nonetheless, we do feel that contrast echocardiography, tissue doppler imaging, and three-dimensional echocardiography are promising additions to perioperative TOE and their principles as well as clinical applications are covered in Chapters 1, 7, and 11. We have also added a new chapter covering the use of TOE during mechanical ventricular assistance, implantation of an artificial heart, and heart transplantation (Chapter 15) in response to the suggestions of our readers.
Our goal is to provide the present and future practitioners of TOE with a comprehensive and updated review of perioperative TOE. We believe that it would have been wrong to restrict the material to only the technical and sonographic aspects of TOE. Therefore, the TOE findings are not presented in isolation, but are accompanied by relevant physiological and clinical data. We hope that this additional information helps the readers to better understand the findings and that it will help them integrate TOE into the diagnostic process in both the operating theatre and in the intensive care unit.
The method of TOE in its existing form satisfies the needs of both anaesthetists and intensivists. Therefore, the main emphasis can now be shifted from the acquisition of new and highly sophisticated techniques to training and certification of physicians who care for cardiac, critically ill, or traumatized patients in operating theatres, intensive care units, and emergency wards. Today a critical and timely diagnosis need never again be missed because of the unavailability of a physician who is certified in TOE. Important guidelines for training and certification of physicians in perioperative TOE were recently published and are included in Chapters 17 and 18. Whereas in the first edition only the certification process in the USA was described, in this edition, we have added a review of the present educational situation of perioperative TOE in Europe and its future prospects are presented.
A prerequisite for proper documentation of perioperative findings is the use of universally accepted terminology for TOE imaging. Chapter 2 describes the practice of perioperative TOE and the whole potential of multiplane TOE imaging in the traditional way. Nevertheless, the twenty TOE images that were recommended in the guidelines for comprehensive intraoperative TOE examination by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force are also presented and the corresponding terminology is used throughout this edition. Some structures cannot be interrogated or correctly imaged in the selected views because of anatomic or pathologic causes. Therefore, the knowledge of alternative views that can be made possible by multiplane TOE imaging remains important.
The findings obtained by perioperative TOE must be stored and readily available to the physicians who might subsequently need them. Comprehensive TOE documentation, including stored images and written reports based on the recommendation mentioned above, may not be feasible in every institution or in every situation. Therefore, we also provide an example of a more realistic TOE report based on a minimum set of TOE images.
Our textbook is the result of a collective effort, and therefore some overlaps are inevitable. Examples are the assessment of intracardiac pressures or of ventricular filling patterns. These techniques and findings are discussed in several chapters in accordance with the respective context. We accepted such minor overlaps when the information appeared useful for the structure of these chapters.
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