# A Study of Factors Predicting Difficulties in Transesophageal Echocardiography (TEE) Probe Insertion in Adult Patients Undergoing Cardiac Surgery

## TL;DR

This study identifies factors like BMI and airway characteristics that predict difficult TEE probe insertion in cardiac surgery patients.

## Contribution

The study provides new predictive factors for difficult TEE probe insertion in adult cardiac surgery patients.

## Key findings

- 30.3% of TEE probe insertions were classified as difficult.
- Male gender, high BMI, and specific airway factors were significantly associated with difficult insertion.
- Jaw thrust was the most effective maneuver for managing difficult insertions.

## Abstract

Background and objective

While transesophageal echocardiography (TEE) is crucial in cardiac surgery, the probe insertion can be challenging. This observational study aimed to identify predictive factors associated with difficult TEE probe insertion in adult cardiac surgery patients.

Methods

A total of 119 adult patients undergoing cardiac surgery were included in the study. Demographic variables (age, gender, and BMI) and airway factors (modified Mallampati classification, modified Cormack-Lehane grading, and thyromental distance) were analyzed. The difficulty of TEE probe insertion was categorized into three grades, and various maneuvers were assessed for difficult insertions.

Results

Of note, 30.3% of insertions were difficult. Male gender (OR: 1.8), BMI ≥30 kg/m2 (OR: 2.5), Mallampati class III-IV (OR: 3.2), Cormack-Lehane grade IIb-IV (OR: 2.7), and thyromental distance <6.5 cm (OR: 1.9) were significantly associated with difficult insertion. Jaw thrust was the most effective maneuver (58.3%) for difficult cases.

Conclusions

Based on our findings, several demographic and airway factors predict difficulties in TEE probe insertion. Understanding these factors can help clinicians anticipate challenges and prepare appropriate strategies, potentially reducing complications associated with probe insertion.