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TEE Risks and Contraindications

When consenting someone for a TEE, you must look for common contraindications as shown below.

Common contraindications 

1. Known esophageal strictures, perforation, lacerations or large diverticula
2. Cervical spine instability
3. Inability to protect the airway (if not intubated).
4. Loose teeth (need a dental exam and possible extraction before proceeding)

Relative Contraindications

1. Dysphagia or odynophagia
2. Recent upper GI bleeding
3. Extensive radiation to the chest and mediastinum
4. Esophageal varices

And finally you must be able to explain the risks of the procedure to a consenting individuals. These are shown below.

Major Risks of TEE

Due to medications used for sedation:

1. Hypotension from sedating medications
2. Methemoglobinemia 
3. Respiratory depression
4. Arrhythmia
5. Paradoxical reaction to sedating medications
6. Infection/Bleeding (from IV insertion site for IV medications)
7. Death 

Due to intubation and probe manipulation:

1. Esophageal trauma, tear or perforation (1/1000 patients)
2. Aspiration
3. Upper GI bleeding
4. Dental injury, aspiration of a loose tooth
5. Displacement of endotracheal and nasogastric tubes

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