The most sensitive and practical technique for detection of myocardial ischemia in die perioperative period is -

Ans. is 'd' i.e., Regional wall motion abnormality detected with the help of 2D transesophageal echocardiography Two dimensional transesophageal echocardiography is the most sensitive method to detect myocardial ischemia in the perioperative period.But there are doubts, if it's a practical procedure too.Morgan states "Detection of regional wall motion abnormality is a rapid and more sensitive indicator of myocardial ischemia than is the E.C.G. but unfortunately TEE requires expensive equipment and considerable familiarity with the technique in order to make correct and rapid interpretations intraoperatively".Other methods available for intraoperative monitoring besides transesophageal echocardiography areElectrocardiography (E.C.G.) - The sensitivity of ECG in detecting ischemia is related to the number of leads monitored.Hemodynamic monitoring - It is done byCentral venous or pulmonary artery pressure monitoring.The most sensitive hemodynamic correlates are derived from pulmonary artery pressure monitoring - Ischemia is frequently but not always associated with an abrupt increase in pulmonary capillary wedge pressure.The most common hemodynamic abnormalities observed during ischemic episodes are hypertension and tachycardia.