Comparison of Passive Head Lift and Combined Chin Lift/Jaw Thrust Maneuvers for Transesophageal Echocardiograph (TEE) Probe Insertion.

BACKGROUND

Transesophageal echocardiography (TEE) is widely used in cardiac and non-cardiac surgeries for real-time cardiac monitoring. However, insertion of the TEE probe under general anesthesia can be challenging.

OBJECTIVES

Aim of the study was to compare the first pass success rate of two maneuvers for TEE probe insertion-passive head lift versus combined chin lift/jaw thrust. Secondary objectives included the number of attempts, time taken for insertion, hemodynamic response, and incidence of oral cavity or mucosal injuries.

METHODS

A prospective, observational study was conducted on 70 adult patients scheduled for elective cardiac surgery under general anesthesia. Eligible patients were assigned to one of two maneuvers: passive head lift (Group A) or combined chin lift/jaw thrust (Group B). The TEE probe insertion was performed by an anesthesiologist experienced in TEE, with another observer recording number of attempts, insertion time, hemodynamic changes at specific time periods, and presence of oral injuries. Statistical analysis included the independent t-test, Wilcoxon-Mann-Whitney U test, Chi-squared test, and Fisher's Exact t test.

RESULTS

The first pass success rate was significantly higher in the passive head lift group (91.4%) compared to the chin lift/jaw thrust group (60%) (P = 0.002). The number of attempts and time taken for insertion were also significantly lower in Group A (P = 0.004 and P = 0.01, respectively). No significant differences in hemodynamic changes or mucosal injuries were observed.

CONCLUSION

The passive head lift maneuver is superior to the combined chin lift/jaw thrust maneuver for TEE probe insertion, with higher success on first attempt, shorter insertion time, and require only a single operator.