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A Practical Approach to Transesophageal Echocardiography on PDA

Section Editor(s): Ellison, NorigStechert, Martin M. MD

doi: 10.1213/01.ANE.0000280196.60905.23
Book and Multimedia Reviews: Media Review

Assistant Professor of Anesthesia; University of California, San Francisco; San Francisco, CA;

A Practical Approach to Transesophageal Echocardiography on PDA

Perrino AC, Reeves ST, eds. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2004. ISBN 0-7817-4349-4, CD ROM $79.95.

Transesophageal echocardiography is a comparatively young diagnostic discipline and as such is being readily adopted not only by cardiac anesthesiologists, but also by general anesthesia practitioners in various settings, including the ICU. A Practical Approach to Transesophageal Echocardiography by Perrino and Reeves published in 2003 in paperback form (a second edition is projected for October 2007) ranks among the standard texts of the discipline. It is the basis for this PDA version.

When evaluating PDA software, the focus should be on how much “assistance” in everyday practice can be obtained. Obvious advantages like easy access and mobility square off with inherent limitations such as limited storage and screen size. Although clinical PDA software is quite popular for concise text blocks such as drug information, it is a matter of individual preference to read complex text as presented in a text book.

This raises the question of where and how TEE-PDA software would be most beneficial for the anesthesiologist. The most appealing clinical environment appears to be in the OR, where textbooks or computer access may not be readily available. To be a helpful asset in this situation, the software must provide instantaneous and well-organized access to pertinent information. Images and video loops must be of sufficient quality to be viewable under bright lights in the operating room. Lastly, the software should assist the clinician with basic calculations occasionally required during a TEE examination.

It should be noted that the author of this review has used Palm software for many years, preferentially for drug reference, calculations, and occasional use of text-based information. The installation of the PDA software on a Treo 680 (Palm) was fairly challenging and required additional software download from the Internet. However, it should be acknowledged that the online (chat) technical support was extremely helpful. To avoid these problems, it is possible to obtain all the relevant software on a memory card for an additional $25.00 from the same distributor. Once installed, the program appears as a standard icon on the familiar Palm interface. One click leads to the main index that can be searched by simple alphabetical query. Alternatively, a figure index and a table of contents view can be chosen as a starting point. Navigation through the pages is highly intuitive and facilitated by additional shortcut buttons in the right corner. The TEE practitioner will find the additional calculator index view that allows access to 19 common cardiac calculations, such as aortic valve area by continuity equation and diverse pressure gradients, particularly useful.

Even though the information is easy to read and well cross-linked, it is not always straightforward to find the specific information sought for. For example: “Commissural mitral view” is not indexed and had to be located by searching through multiple levels. Once found, the image plane and orientation is well described, including specific leaflet nomenclature. Unfortunately, this leaflet specification is missing on the image that is linked to the text. In general, the image quality and annotations are quite good, although appreciation of detail is limited by the small screen size. Regretfully, the included zoom function only works negatively (i.e., zooms farther out). The total number of TEE images is limited to 100 and does not match the abundance of text information that includes a variety of tables. Presumably, as a concession to limited storage space, video loops have not been included in the software.

In summary, A Practical Approach to Transesophageal Echocardiography on PDA is interesting, although for the immediate application in the OR the use may be limited. It may appeal to TEE practitioners who seek to refresh their basic knowledge between cases. Since the second edition of the printed version is to be published in October 2007, the author of this review is looking forward to an updated version of the PDA software as well. Improvements in indexing, zoom function, and inclusions of video loops as well as the ability to perform a free text search would make the software a much better companion for the perioperative echocardiographer.

Martin M. Stechert, MD

Assistant Professor of Anesthesia

University of California, San Francisco

San Francisco, CA

© 2007 International Anesthesia Research Society