๐ During Pre Anesthetic Evaluation, to rule out structural heart disease. For e.g. A recent study identified a 12% incidence of moderate to severe aortic stenosis in unselected fractured neck of femur patients.
๐ When the nature of the planned surgery might result in severe haemodynamic, pulmonary or neurological compromise e.g. Neurosurgical procedures in the semi-sitting position, liver transplantation, scoliosis surgery, endovascular aortic stent graft placement and resection of renal tumours that extend into the inferior vena cava
๐ When the patient’s known or suspected cardiovascular pathology might result in severe haemodynamic, pulmonary or neurological compromise e.g. patients with dynamic outflow tract obstruction secondary to hypertrophic cardiomyopathy and those with ventricular assist devices in place.
๐Trans Esophageal Echo (TEE) can assess the volume status intraoperatively
๐ Persistent unexplained hypotension : Causes can be LV systolic or RV dysfunction, severe MR , dynamic LV outflow obstruction, cardiac tamponade , aortic dissection ( TEE is the technique of choice) , large pleural effusion etc
๐ Persistent unexplained hypoxaemia : A Patent Foramen Ovale can cause this
Reference: AAGBI Core Topics in Anaesthesia 2015 , Echocardiography and Anaesthesia, Jonathan H. Rosser and Nicholas J. Morgan-Hughes
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