TOE Monitoring Severe AS — FRCA Final MCQ

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HardGeneral AnaesthesiaTOE Monitoring Severe ASFRCA Final

A 72-year-old man (ASA IV) with severe aortic stenosis undergoes emergency laparotomy under general anaesthesia. Which monitoring modality provides the most useful real-time haemodynamic information for managing this patient?

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Correct answer: C — Transoesophageal echocardiography

In a patient with severe aortic stenosis undergoing major emergency surgery, transoesophageal echocardiography (TOE) provides the most comprehensive real-time haemodynamic assessment: direct visualisation of ventricular function, valve function, volume status (LV end-diastolic area), wall motion abnormalities (ischaemia detection), and cardiac output. It can guide fluid management, vasoactive drug titration, and detect acute complications (dynamic LVOT obstruction, systolic anterior motion of the mitral valve). While invasive arterial monitoring is essential, TOE provides information that no other single monitor can match.

Reference: RCOA – 2023 – Cardiac anaesthesia; BSECHO – 2021 – Intraoperative TOE guidelines