Emergence and distribution of ultrasound made some kind of revolution in anesthesiology and resuscitation. It was connected with the fact that the possibility of assessment of some important indicators at a bed of the patient, performing urgent ultrasonographies and also ultrasonic maintenance of many manipulations appeared.
In parallel there was a wide circulation of an echocardiography - ultrasound examination of heart. Carrying out an echocardiography in the conditions of intensive care unit and resuscitation allowed to carry out quickly the assessment of warm emission, contractility of a myocardium, to diagnose a cardiac tamponade, a thromboembolism of a pulmonary artery and other medical emergencies.
However carrying out an external echocardiographic research in process performance of operation is complicated for a number of reasons. At the anesthesiologist access to a thorax of the patient is complicated, there are objective difficulties in use of this or that echocardiographic position. It has special value at cardiac operations, that is just when the intraoperative echocardiography is a valuable diagnostic method. Therefore use of a transesophageal echocardiography allowed to solve the mass of problems and to receive a valuable diagnostic method.
Indications for a transesophageal echocardiography include assessment of hemodynamically unstable patients who are on IVL at cardiac operations, at a chest aorta operations, at the other interventions which are followed by disturbances of a hemodynamics at the patient. Also as indications serve expanded surgical interventions at which various frustration of a hemodynamics are possible.
Absolute contraindications to CHPEKHOKG are earlier executed removal of a gullet, heavy obstruction of a gullet, perforation of a gullet, the proceeding bleeding from a gullet. Carry to relative contraindications a gullet diverticulum, it varicose expanded veins, esophageal fistula, the undergone gullet and stomach operations, radiation of a mediastinum at oncological pathology, inexplicable difficulties of swallowing and other states at which introduction of the sensor to a gullet is dangerous.
For carrying out a transesophageal echocardiography special ultrasonic sensors are used. It include the tiny echocardiographic converter mounted on the end of a flexible basis of a fibrogastroskop for carrying out in a gullet. As a rule, the sensor has in the basis the phased lattice from 64 piezoelectric elements with a frequency of radiation from 3.7 to 7.5 MHz. By means of consecutive radiation these elements and the acoustic lens which is built in the sensor housing ultrasonic waves form the 90-degree sector of radiation from 2 to 10 mm thick, outgoing at right angle to the sensor. The movement of the distal site of the device is regulated by two rotating handles ("wheels"), as well as in a usual fibrogastroskop.
For carrying out a research use various programs of visualization. In those situations when there is no time for carrying out an expanded research, first of all the basic echocardiographic estimates provided in recommendations for a perioperatsionny CHPEKHOKG such as detection of significant disturbances in filling and function of ventricles of heart, the expressed ischemia or a myocardial infarction, big air emboluses, heavy dysfunction of valves, big new growths and blood clots in heart, liquid in a pericardium and also serious damages of the main vessels are carried out. Achievement of the specified diagnostic purposes requires at least eight echocardiographic positions. For carrying out full inspection use twenty positions. If anesthesia and CHPEKHOKG is carried out by one person, then it is expedient to execute at first basic inspection, then if time — full allows.
When performing a transesophageal echocardiography fillings of ventricles of heart carry out the assessment, estimate their systolic and diastolic function, reveal myocardium ischemia. CHPEKHOKG radically changed surgery of valves of heart, having provided to surgical crew exact display of consequences of surgical intervention in the operating room when any necessary correction can be executed immediately.
Earlier echocardiographic data were archived by means of a video, and the corresponding conclusions invested in the history of diseases. Now the standard is digital record of one or several cardial cycles. The records which turned out thus can be maintained and also are used in intrahospital network for fast access for specialists doctors to data.