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Table 6 Methods to decrease the risk of variceal rupture during intraoperative TEE in liver transplantation

From: Complications related to intraoperative transesophageal echocardiography in liver transplantation

1. Allow TEE examinations to be performed by experienced operators with strict vigilance (Practice guidelines for perioperative transesophageal echocardiography. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography 2010; Kallmeyer et al. 2001; Daniel et al. 1991)

2. Obtain a gastroenterology consultation for preoperative variceal banding (Hahn et al. 2013)

3. Perform TEE after correcting coagulopathies (Hilberath et al. 2010)

4. Use rigid laryngoscope-assisted insertion of the probe to reduce the incidence of oropharyngeal mucosal injury and the number of insertion attempts (Na et al. 2009)

5. Abandon TEE examination if probe insertion or advancement is difficult (Kallmeyer et al. 2001)

6. Limit insertion of the probe to a midesophageal level (Aniskevich et al. 2010)

7. Avoid a wide range of probe tip flexion and unnecessary probe manipulation (Augoustides et al. 2006)

8. Avoid manipulation in a fixed flexion position (Augoustides et al. 2006)

9. Use a TEE probe with a temperature-control mechanism (Kharasch and Sivarajan 1996)

10. Place the TEE in “freeze” mode when not obtaining images (Kharasch and Sivarajan 1996)

11. Remove the TEE probe as soon as possible to limit the thermal and mechanical effects (Kharasch and Sivarajan 1996)

  1. TEE transesophageal echocardiography