The use of echocardiography as a routine perioperative monitoring standard: The perspective of a cardiothoracic anesthesiologist

I Ketut Wibawa Nada, Adinda Putra Pradhana

I Ketut Wibawa Nada
Anesthesiology and Intensive Therapy Department Udayana University - Sanglah General Hospital Denpasar - Bali Kesehatan Street No 1 Ph/Fax: +62 361 257361/235980 Email:

Adinda Putra Pradhana
Anesthesiology and Intensive Therapy Department Udayana University - Sanglah General Hospital Denpasar - Bali Kesehatan Street No 1 Ph/Fax: +62 361 257361/235980 Email: Email:
Online First: April 30, 2019 | Cite this Article
Nada, I., Pradhana, A. 2019. The use of echocardiography as a routine perioperative monitoring standard: The perspective of a cardiothoracic anesthesiologist. Bali Journal of Anesthesiology 3(1): 58-61. DOI:10.15562/bjoa.v3i1.144


In the era of medicine that has been very advanced as it is today, we as anesthesiologists are required to be able to provide anesthetic services that are comfortable but still safe. Throughout the world, there are more than 300 million major surgery each year, and major cardiovascular adverse events are a significant cause of perioperative morbidity and mortality.1 This certainly relates to the nature of anesthetic agents that are mostly cardiovascular-depressant. Anesthetic agents such as propofol, ketamine, opioids, inhalation anesthetic agents, and many others, can directly affect the cardiovascular system.2

While the major cardiac event occurred during perioperative events is also quite high. Especially for the patients in the perioperative period who will undergo non-cardiac surgery. This frequently reduces the alertness of an anesthesiologist, especially when performing perioperative monitoring. A study from Smilowitz et al.,1 showed that out of 10,581,621 patients admitted to hospital for major non-cardiac surgery plans, 317,479 (3%) patients had experienced major cardiac events. Which can be illustrated that major cardiac events occur in 1 in 33 patients treated for major non-cardiac surgery. Echocardiography is a safe, relatively inexpensive and well-tolerated action for patients.3

Regular use of echocardiography in the perioperative period can certainly help to predict and even reduce major events adverse cardiac events. It is good to be used as a guide for making decisions in carrying out actions, as well as for monitoring the patient's condition regularly during the perioperative period. The use of echocardiography so far has been used for both diagnosis and management in the field of cardiology and is used by another specialist as well, although anesthesiologists do not use it in the perioperative period as a routine manner. Meanwhile, the role of an anesthesiologist as a perioperative doctor has become something that other specialties have begun to rely on.4



Smilowitz NR, Gupta N, Ramakrishna H, et al. Trends in Perioperative Major Adverse Cardiovascular and Cerebrovascular Events associated with Non-Cardiac Surgery. JAMA Cardiol. 2018; 2(2): 181–7. DOI: 10.1001/jamacardio.2016.4792.Trends

Ouanes J-PP, Tomas VG, Sieber F. Special Anesthetic Consideration for the Fragility Fracture Patient. Clin Geriatr Med. 2015; 30(2): 243–59. DOI: 10.1016/j.dcn.2011.01.002.The

Bartel T, Müller S, Biviano A, et al. Why is intracardiac echocardiography helpful? Benefits, costs, and how to learn. Eur Heart J. 2014; 35(2): 69–76. DOI: 10.1093/eurheartj/eht411

Margale S, Marudhachalam K, Natani S. Clinical application of point of care transthoracic echocardiography in perioperative period. Indian J Anaesth. 2017; 61(1): 7–16. DOI: 10.4103/0019-5049.198407

Goyal S, Singh A. The Origin of Echocardiography. Texas Hear Inst J. 2007; (34):431–8. Available at:

Canty DJ, Royse CF. Audit of anaesthetist-performed echocardiography on perioperative management decisions for non-cardiac surgery. Br J Anaesth. 2009; 103(3): 352–8. DOI: 10.1093/bja/aep165

O’Halloran TD, Kannam JP. Preoperative transthoracic echocardiography: When is it useful?. Int Anesthesiol Clin. 2008; 46(2): 1–10. DOI: 10.1097/AIA.0b013e

Heiberg J, El-Ansary D, Royse CF, et al. Transthoracic and transoesophageal echocardiography: a systematic review of feasibility and impact on diagnosis, management and outcome after cardiac surgery. Anaesthesia. 2016; 71(10): 1210–21. DOI: 10.1111/anae.13545

Biswas A, Yassin MH. Comparison between transthoracic and transesophageal echocardiogram in the diagnosis of endocarditis: A retrospective analysis. Int J Crit Illn Inj Sci. 2015; 5(2): 130–1. DOI: 10.4103/2229-5151.158429

Lyons K, Bhamidipati K. 4 Comparison of transthoracic and transoesophageal echocardiography in the diagnosis of infective endocarditis – a tertiary centre experience. In: Oral abstract presentations 1. BMJ Publishing Group Ltd and British Cardiovascular Society; 2017. p. A3.1-A3. DOI: 10.1136/heartjnl-2017-ICS17.4

Shillcutt SK, Bick JS. A Comparison of Basic Transthoracic and Transesophageal Echocardiography Views in the Perioperative Setting. Anesth Analg. 2013 Jun; 116(6): 1231–6. DOI: 10.1213/ANE.0b013e31828cbaca

A updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Practice guidelines for perioperative transesophageal echocardiography. Anesthesiology. 2010; 112: 1084–96.

Shanewise JS, Cheung AT, Aronson S, et al. ASE/SCA Guidelines for Performing a Comprehensive Intraoperative Multiplane Transesophageal Echocardiography Examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography. Anesth Analg. 1999 Oct; 89(4): 870. DOI: 10.1213/00000539-199910000-00010

Cowie B. Focused Cardiovascular Ultrasound Performed by Anesthesiologists in the Perioperative Period: Feasible and Alters Patient Management. J Cardiothorac Vasc Anesth. 2009; 23(4): 450–6. DOI: 10.1053/j.jvca.2009.01.018

No Supplementary Material available for this article.
Article Views      : 340
PDF Downloads : 158