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Once the patient is anesthetized and the trachea securely intubated, the contents of the stomach are suctioned. Gentle massage of the left upper quadrant of the abdomen during suctioning may help remove air, which can otherwise degrade imaging. The patient's neck is then extended, and a well-lubricated TEE probe is introduced into the midline of the hypopharynx with the transducer side facing anteriorly. Usually, with minimal force, the probe will pass blindly into the esophagus, especially if the neck is extended. If the probe does not pass blindly, a laryngoscope is used to lift the larynx anteriorly and the probe is placed into the esophagus under direct vision. During transducer insertion or withdrawal, the controls of the gastroscope must be in the neutral or relaxed position to allow the transducer to follow the natural course of the esophagus, thereby potentially minimizing the risk of injury.
Figure 33-6
The terminology used to describe TEE probe movements
is illustrated. (From 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 89:870–884, 1999.)
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