Perioperative Point-of-Care Ultrasound Use by Anesthesiologists

The Effect of the Ultrasonography Measurement Method and the Conventional Measurement Method Used in Endotracheal Tube Size Selection in the Pediatric Patient Group on Postextubation Complications and Patient Recovery

INTRODUCTION

 In this study, we aimed to compare the cuffed intubation tube selected with the Cole formula and tracheal ultrasonography (USG) measurement method regarding postextubation complications in providing airway patency and determine its effects on patient recovery.

MATERIALS AND METHOD

 Between 01 July 2022 and 30 June 2023, American Society of Anesthesiologists (ASA) risk group I-III, 4-6-year-old patients who underwent pediatric orthodontic surgery (multiple tooth extraction) were included in the study. Data of age, gender, weight, ASA risk group, history, Cole formula, USG measurement results used in the endotracheal tube (ETT) selection (one of the two whichever application was used), fasting time, intubation success, operation time, 30th-minute modified Aldrete recovery score (MASS), and postoperative complications due to intubation (within the first postoperative hour) were analyzed retrospectively. The patients were divided into two groups according to the method used by the anesthesiologists in selecting the ETT at the beginning of the operation. The group that used Cole formula management was named I, while the group that used the USG measurement method was called II. Intubation-related complication data of the patients in the first 1 hour postoperatively and MASS values at the 30th minute were compared between the groups.

RESULTS

In this study, 52.5% of the cases were male (n=42), 47.5% were female (n=38), the mean age was 4.84±0.84 years, and the mean body weight was 22.56±7.58 kilogram. There was no statistically significant difference between the groups regarding age, gender, body weight, ASA score, operation time, and period without oral consumption. ETT diameter measurement values according to groups were 4.73±0.46 mm in Group I and 4.41±0.61 mm in Group II. Postoperative 30th-minute MASS values were median 7 in Group I and median 8 in Group II (p<.001). MASS values were significantly higher in the Group II patient group. Intubation-related complications (postoperative cough, stridor, laryngospasm, tachypnea, wheezing, dysphonia) were observed in Group I with a rate of 40% within the first postoperative hour, while complications were marked with a rate of 17.5% in Group II (p=0.026). Complications in group II were significantly lower.

CONCLUSION

 In the pediatric age group, especially under the age of 6, trachea measurement with USG and ETT selection is an effective, safe, and noninvasive method compared to other conventional methods. ETT size selection with USG accelerates postoperative patient recovery and reduces the risk of intubation-related complications. In addition, inflating the tube cuff under USG guidance can prevent cuff-related complications.

Point-of-Care Ultrasonography in Internal Medicine: Limitations and Pitfalls for Novice Users

Point-of-care ultrasound (POCUS) is increasingly being adopted in the field of internal medicine, leading to the development of POCUS curricula in undergraduate and postgraduate medical education programs. Prominent internal medicine societies and organizations worldwide recognize the expanding utilization of POCUS by internal medicine physicians, emphasizing the need for practitioners to be aware of both its benefits and limitations. Despite the growing enthusiasm for POCUS, clinicians, particularly those with limited clinical experience, must be cautious regarding its inherent limitations and the potential impact on their clinical practice. This review aims to outline the limitations and potential drawbacks of POCUS for medical students, residents, and internists who wish to stay abreast of the escalating use of POCUS in internal medicine and have a desire, or have already commenced, to incorporate POCUS into their practice. Additionally, it provides recommendations for enhancing POCUS proficiency to mitigate these limitations.

Use of Point-of-Care Ultrasound and Focus-Assessed Transthoracic Echocardiography to Diagnose Acute Right Heart Failure Due to Fat Emboli in a Parturient

Fat embolism syndrome (FES), causing right heart dysfunction, is a rare disease that is often difficult to diagnose with imaging modalities such as computed tomography (CT). FES is the clinical presentation that follows the entry of fat globules into the systemic circulation, which typically results in respiratory failure, scattered petechiae, cardiovascular collapse, and neurological sequelae. It is mostly observed in the cases of orthopedic trauma but may occur in any circumstance where fat can enter the circulatory system. In this case report, the authors describe an atypical presentation of FES in a 24-week parturient. The use of bedside point-of-care ultrasonography (POCUS) and the focus-assessed transthoracic echocardiography (FATE) protocol aided in the prompt diagnosis of right heart failure and helped to confirm the diagnosis of FES with more advanced imaging technology.