Focused cardiac and lung ultrasonography: implications and applicability in the perioperative period

Abstract

Focused ultrasonography in anesthesia (FUSA) can be a procedural and diagnostic tool, as well as potentially a tool for monitoring, and can facilitate the perioperative management of surgical patients. Its utilization is proposed within the anesthesiologist and/or intensivist scope of practice. However, there are significant barriers to more generalized use, but evidence continues to evolve that might one day make this practice a standard of care in the perioperative period.Currently, the most widely used applications of FUSA include the guidance and characterization of perioperative shock (acute cor pulmonale, left ventricular dysfunction, cardiac tamponade, and hypovolemia) and acute respiratory failure (pneumothorax, acute pulmonary edema, large pleural effusion, major atelectasis, and consolidation). Increased diagnostic accuracy of all of these clinical conditions makes FUSA valuable in the perioperative period. Furthermore, FUSA can be applied to other anesthesiology fields, such as airway management and evaluation of gastric content in surgical emergencies.

Focus-assessed transthoracic echocardiography: Implications in perioperative and intensive care

“…[30] Characterization of perioperative shock in conditions such as cardiac tamponade, hypovolemia, LV dysfunction, acute cor pulmonale, and acute respiratory failures such as pneumothorax, acute pulmonary edema, massive pleural effusion, and major atelectasis can be done. [31]…”

“…[1333] Focused Echocardiography in Emergency Life support[34] is a limited echo protocol with limited training for catastrophic conditions. [8] Focused ultrasonography in anesthesia[31] and Rapid Ultrasound in Shock[35] are few more.…”

The role of ultrasonography in anesthesia for bariatric surgery

“…This modality is known as rescue transthoracic echocardiography (TTE), hemodynamic TTE, focal cardiac ultrasonography (FOCUS), and point-of-care ultrasound (POCUS). [ 58 59 60 61 ]…”

Point-of-care Ultrasound in Anaesthesia and Intensive Care Medicine

“…Typically, it focuses on answering a particular question relevant to the current clinical situation, and does not replace detailed diagnostic imaging interpreted by a radiologist (or cardiologist for echocardiography) [5]. The most common diagnostic application of POC US at present is in the management of undifferentiated shock [6] with a number of protocols published on how to systematically incorporate POC US into the assessment and management of these patients. These protocols include focused cardiac, lung and abdominal US, mainly differing on the priority of the exam sequence [7].…”

“…Normal aerated lungs are not visible with US, LUS therefore relies on the recognition of patterns that are pathognomonic for particular disease processes. LUS has excellent sensitivity and specificity in identifying pneumothorax, chronic obstructive pulmonary disease, pneumonia and pulmonary oedema [6]. LUS is included in a number of systematic protocols to aid the assessment of patients in respiratory distress (BLUE protocol) and/ or circulatory collapse (FALLs protocol) [12].…”