The Impact of Routine Focused Transthoracic Echocardiography Immediately before Renovascular Surgery in Patients with End Stage Renal Disease– A Brief Report - Abstract
Background: Patients with end stage renal disease (ESRD) have a high incidence of postoperative cardiac morbidity and mortality. The frequent presence of cardiac disease, extreme states of hydration and reduced ability to excrete a fluid load pose challenges to anesthetic management. Routine preoperative focused transthoracic echocardiography (TTE) may assist in improved cardiac and hemodynamic state assessment directing more rational anesthetic care in these high-risk patients.
Methods: An audit was performed on focused TTE performed by an anesthesiologist immediately before renovascular surgery in 18 sequential patients with ESRD. Data recorded included the quality and time to acquire echocardiography images and their influence on anesthetic management.
Results: Interpretable images were obtained in 15 of 18 patients during the study period (83%). Hypovolemia was revealed in 33%, which lead to an intravascular fluid bolus immediately before surgery.
Conclusion: Routine anesthesiologist-performed preoperative focused TTE detected hypovolemia and facilitated anesthetic management in one third of patients with ESRD presenting for renovascular surgery.