Transesophageal echocardiography in liver transplantation: Current status and practices among anaesthesiologists in India

Intraoperative transesophageal echocardiography TEE has been increasingly used for major surgeries over the past 20 years. Though its use is more frequent in cardiac surgeries it has grown more significantly during liver transplant surgeries too now a days. The  Society of Cardiovascular Anaesthesia in conjunction with the American Society of Anaesthesiologists first suggested the benefit of TEE use in non cardiac surgeries presenting with hemodynamic instability. The Society for the advancement of Transplant Anaesthesia SATA has created a working group on TEE to describe guidelines for its best possible use in liver transplantation. The anaesthetic management of liver transplantation is more challenging due to  prior poor cardiac condition and intraoperative major hemodynamic shifts that necessitates the use of TEE. TEE assess dynamic cardiac function and contractility volume status valvular function pericardial tamponade and major vessel thromboembolism. TEE use is very much safe with minimal complications but the use is very limited due to unfamiliarity of this modality among the anaesthesiologists less expertise and training .