Transoesophageal echocardiography in high risk surgery

摘要

Intraoperative transoesophageal echocardiog-raphy (TOE) is widely regarded as essential for a range of high-risk surgical procedures, is recommended by numerous international practice guidelines, and is increasingly used in cardiac anaesthesia. As a result, accreditation in TOE is considered mandatory for those aspiring to a career in some subspecialties of anaesthesia. Despite its widespread use there is a paucity of prospective, randomized, high-quality evidence that intraoperative TOE improves patient outcome. This article considers the evidence supporting intraoperative TOE and the development of guidelines based on this evidence. This allows reflection on the nature of an evidence base, and how similar problems have shaped the use of other diagnostic techniques.