1
|
Naji A, Chappidi M, Ahmed A, Monga A, Sanders J. Perioperative Point-of-Care Ultrasound Use by Anesthesiologists. Cureus 2021; 13:e15217. [PMID: 34178536 PMCID: PMC8221658 DOI: 10.7759/cureus.15217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Point-of-Care ultrasound (POCUS) is the bedside utilization of ultrasound, in real-time, to aid in the diagnosis and treatment of patients. Image acquisition from POCUS utilization by anesthesiologists involves the assessment of multiple organs in different perioperative situations. POCUS can be utilized to enhance clinical decision-making in a variety of perioperative situations due to its ability to assess endotracheal tube placement, cardiac function, pulmonary function, aspiration risk, hemodynamics, vascular access, and nerve visualization for regional procedures. The mounting clinical evidence for the value of POCUS in perioperative settings, its growing affordability, and its low associated risks are responsible for the nationwide movement across many anesthesiology residency programs to increase the focus on perioperative ultrasound training. The purpose of this review is to present to current anesthesiologists and anesthesiology trainees, a broad discussion regarding the diverse utility and importance of POCUS in perioperative settings.
Collapse
Affiliation(s)
- Abdullah Naji
- Anesthesiology and Perioperative Medicine, Oregon Health Science University Hospital, Portland, USA
| | - Monica Chappidi
- Anesthesiology, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, USA
| | | | - Aaron Monga
- Anesthesiology, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, USA
| | | |
Collapse
|
2
|
Point-of-care ultrasound in pediatric anesthesia: perioperative considerations. Curr Opin Anaesthesiol 2020; 33:343-353. [PMID: 32324662 DOI: 10.1097/aco.0000000000000852] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review the perioperative applications of point-of-care ultrasound (POCUS). RECENT FINDINGS The role of point-of-care ultrasonography for perioperative care is expanding with respect to perioperative application. The imaging approach can complement the physical exam and provide additional information for decision-making in pediatric perioperative medicine. This review will focus on applications in the following organ systems: airway, cardiac, pulmonary and gastric. Specifically, POCUS of the airway has been used to optimize endotracheal tube depth, aid in tube size selection and predict difficulty with laryngoscopy and intubation. Lung POCUS has been used to assess for causes hypoxemia as well as to optimize ventilatory mechanics. Cardiac POCUS has been used for assessment of hemodynamics, valvular and ventricular function. Gastric ultrasound has emerged as an evaluative mechanism of gastric content in the setting of fasting as well as to confirm placement of gastric tubes. The applications of POCUS in the perioperative setting continue to evolve as a reliable diagnostic tool that can assist in timely diagnosis, improve procedural safety and has the potential to improve patient outcomes. SUMMARY The utility of perioperative POCUS has been well demonstrated, specifically for examination of the airway, stomach and cardiopulmonary system. It is advisable for the novice sonographer to perform POCUS within the guidelines set by the American Society of Echocardiography regarding basic POCUS. As with all diagnostic modalities, understanding the limitations of ultrasound and POCUS as well as continuous self-assessment is crucial.
Collapse
|
3
|
Li L, Yong RJ, Kaye AD, Urman RD. Perioperative Point of Care Ultrasound (POCUS) for Anesthesiologists: an Overview. Curr Pain Headache Rep 2020; 24:20. [DOI: 10.1007/s11916-020-0847-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
4
|
Mizubuti GB, Allard RV, Ho AMH, Wang L, Beesley T, Hopman WM, Egan R, Sydor D, Engen D, Saha T, Tanzola RC. [Knowledge retention after focused cardiac ultrasound training: a prospective cohort pilot study]. Rev Bras Anestesiol 2019; 69:177-183. [PMID: 30665672 DOI: 10.1016/j.bjan.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 09/13/2018] [Accepted: 10/31/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Focused Cardiac Ultrasound (FoCUS) has proven instrumental in guiding anesthesiologists' clinical decision-making process. Training residents to perform and interpret FoCUS is both feasible and effective. However, the degree of knowledge retention after FoCUS training remains a subject of debate. We sought to provide a description of our 4-week FoCUS curriculum, and to assess the knowledge retention among anesthesia residents at 6 months after FoCUS rotation. METHODS A prospective analysis involving eleven senior anesthesia residents was carried out. At end of FoCUS Rotation (EOR) participants completed a questionnaire (evaluating the number of scans completed and residents' self-rated knowledge and comfort level with FoCUS), and a multiple-choice FoCUS exam comprised of written- and video-based questions. Six months later, participants completed a follow-up questionnaire and a similar exam. Self-rated knowledge and exam scores were compared at EOR and after 6 months. Spearman correlations were conducted to test the relationship between number of scans completed and exam scores, perceived knowledge and exam scores, and number of scans and perceived knowledge. RESULTS Mean exam scores (out of 50) were 44.1 at EOR and 43 at the 6-month follow-up. Residents had significantly higher perceived knowledge (out of 10) at EOR (8.0) than at the 6-month follow-up (5.5), p=0.003. At the EOR, all trainees felt comfortable using FoCUS, and at 6 months 10/11 still felt comfortable. All the trainees had used FoCUS in their clinical practice after EOR, and the most cited reason for not using FoCUS more frequently was the lack of perceived clinical need. A strong and statistically significant (rho=0.804, p=0.005) correlation between number of scans completed during the FoCUS rotation and 6-month follow-up perceived knowledge was observed. CONCLUSION Four weeks of intensive FoCUS training results in adequate knowledge acquisition and 6-month knowledge retention.
Collapse
Affiliation(s)
- Glenio B Mizubuti
- Queen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá
| | - Rene V Allard
- Queen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá
| | - Anthony M-H Ho
- Queen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá
| | - Louie Wang
- Queen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá
| | | | - Wilma M Hopman
- Queen's University, Kingston Sciences Centre Research Institute and Public Health Sciences, Kingston, Canadá
| | - Rylan Egan
- Queen's University, Healthcare Quality Graduate Programs, Kingston, Canadá
| | - Devin Sydor
- Queen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá
| | - Dale Engen
- Queen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá
| | - Tarit Saha
- Queen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá
| | - Robert C Tanzola
- Queen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá.
| |
Collapse
|
5
|
MacKay EJ, Patel PA, Gutsche JT, Weiss SJ, Augoustides JG. Contemporary Clinical Niche for Intra-Aortic Balloon Counterpulsation in Perioperative Cardiovascular Practice: An Evidence-Based Review for the Cardiovascular Anesthesiologist. J Cardiothorac Vasc Anesth 2017; 31:309-320. [DOI: 10.1053/j.jvca.2016.07.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Indexed: 01/10/2023]
|
6
|
Abstract
AIM The aim of this article is to impart knowledge concerning focused transesophageal echocardiographic examination (TEE) for non-cardiac surgery which is an essential part of perioperative monitoring. It allows a rapid echocardiographic examination without interference with the surgical field or under limited transthoracic examination conditions. New recommendations for a comprehensive perioperative TEE examination with expanded standard views and the recently published consensus statement for a shortened baseline examination were crucial for this study. MATERIAL AND METHODS The background is the peer-reviewed literature from PubMed. RESULTS Apart from cardiac surgery TEE has two main applications: firstly, the evaluation of patients developing acute life-threatening hemodynamic instability in the operating room, in the emergency room or in the intensive care unit (ICU). Secondly, TEE is used as planned intraoperative monitoring when severe hemodynamic, pulmonary or neurological complications are expected because of the type of surgery or due to the cardiopulmonary medical history of the patient. In 2013 a total of 11 relevant standard views were defined for the basic perioperative TEE examination in non-cardiac surgery. These 11 views should be performed for each patient. Appropriate extension to a comprehensive examination may be necessary if complex pathology is obvious. DISCUSSION Even in non-cardiac surgery TEE is an important tool allowing clarification of a life-threatening perioperative hemodynamic instability within a few minutes. Furthermore, the hemodynamic management of high-risk patients can be facilitated. Appropriate qualification and continuous training are necessary in order to assure the competence of the examiner.
Collapse
|
7
|
Adler AC, Greeley WJ, Conlin F, Feldman JM. Perioperative Anesthesiology UltraSonographic Evaluation (PAUSE): A Guided Approach to Perioperative Bedside Ultrasound. J Cardiothorac Vasc Anesth 2015; 30:521-9. [PMID: 27013122 DOI: 10.1053/j.jvca.2015.11.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Indexed: 01/29/2023]
Affiliation(s)
- Adam C Adler
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiothoracic Anesthesiology; The Children's Hospital of Philadelphia, Philadelphia, PA.
| | - William J Greeley
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiothoracic Anesthesiology; The Children's Hospital of Philadelphia, Philadelphia, PA; The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Frederick Conlin
- Department of Anesthesiology, Baystate Medical Center, Springfield, MA; Tufts University School of Medicine, Boston, MA
| | - Jeffrey M Feldman
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiothoracic Anesthesiology; The Children's Hospital of Philadelphia, Philadelphia, PA; The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| |
Collapse
|
8
|
Mizubuti GB, Allard RV, Tanzola RC, Ho AM. Pro: Focused Cardiac Ultrasound Should be an Integral Component of Anesthesiology Residency Training. J Cardiothorac Vasc Anesth 2015; 29:1081-5. [DOI: 10.1053/j.jvca.2015.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Indexed: 01/06/2023]
|
9
|
Alfirevic A. Con: Perioperative Transthoracic Echocardiography Should Not Be an Integral Part of the Anesthesiology Residency Core Curriculum. J Cardiothorac Vasc Anesth 2015; 29:1086-8. [PMID: 26279225 DOI: 10.1053/j.jvca.2015.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Andrej Alfirevic
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH.
| |
Collapse
|
10
|
|
11
|
Nowak M, Rosenberger P, Felbinger TW, Götz AE, Shernan SK, Unertl K, Eltzschig HK. Perioperative Echokardiographie. Anaesthesist 2006; 55:337-61. [PMID: 16520927 DOI: 10.1007/s00101-006-0992-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Over the past decades, echocardiography has undergone a continuous evolution in technology that has promoted its clinical application and acceptance throughout perioperative medicine. These technological advances include improvements in transducer development that permit superior imaging quality and a wider selection of probes for epicardial, epiaortic, and surface echocardiography which can also be used in conjunction with multiplane transesophageal echocardiography. Moreover, the addition of Doppler technology and digital acquisition has secured the role of echocardiography as a valuable and relatively noninvasive diagnostic tool for the assessment of cardiovascular disease and hemodynamic monitoring throughout the perioperative period. Therefore, it has become increasingly important for perioperative physicians to understand the basic principles and underlying fundamental concepts pertaining to the technology and physics of echocardiography, as well as its inherent limitations. The current review outlines the modes and applications of different echocardiographic techniques used in perioperative echocardiography including M-mode, two-dimensional echocardiography, and Doppler assessment of blood flow. In addition, the limitations of these techniques and typical artifacts associated with the perioperative use of echocardiography are described.
Collapse
Affiliation(s)
- M Nowak
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | |
Collapse
|