Three years’ experience of focused cardiovascular ultrasound in the peri‐operative period

Abstract

SummaryUltrasound applications in peri-operative medicine have become common place in modern anaesthesia practice. Anaesthetists have performed transoesophageal echocardiography in cardiac and selected non-cardiac surgery for over two decades. We aimed to assess the indications, impact on clinical management and accuracy of focused cardiovascular ultrasound performed by anaesthetists in the peri-operative period. One hundred and seventy patients over a 3-year period had a focused transthoracic echocardiogram. Adequate images to answer the clinical question were obtained in 167 out of 170 patients (98%). The undifferentiated systolic murmur was the commonest indication (98 out of 170, 58%). Some degree of aortic stenosis was present in 47 out of 170 (26%) of patients; mitral valve disease (30 out of 170 (18%)) and pulmonary hypertension (25 out of 170 (14%)) were also common. Changes in peri-operative management occurred in 140 out of 170 (82%) patients and major findings correlated with a formal cardiology transthoracic echocardiogram in 52 out of 57 (92%) patients. Focused cardiovascular ultrasound performed by anaesthetists in the peri-operative period accurately detects major cardiac pathology and significantly alters peri-operative management.

The impact of pre‐operative focused transthoracic echocardiography in emergency non‐cardiac surgery patients with known or risk of cardiac disease

“…Conversely, a clinically unimportant finding or normal TTE had the effect of reassuring the anaesthetist, leading to a reduced requirement for further investigation, reduced invasive peri-operative monitoring and reduced postoperative level of care. The proportions of management changes were less than in three previous reports of peri-operative focused TTE [14,18,19], which could be due to differences in management definitions and patient cohorts.…”

Unrecognized tamponade diagnosed pre-induction by focused echocardiography

“…18 With appropriate training, these images can be interpreted with a high degree of correlation with expert assessment. 17,[19][20][21] Additionally, the technical skills needed for basic image acquisition can be successfully taught to trainees in anesthesiology using both simulation and curriculum implementation. [22][23][24] The knowledge base necessary for interpretation is based on pattern recognition and ''goalfocused'' assessment.…”

A systematic review of transthoracic and transesophageal echocardiography in non-cardiac surgery: implications for point-of-care ultrasound education in the operating room

“…[9][10][11][12][13][14][15][16][17][18][19][20] All the studies were reported as comprehensive examinations, which was reflected in the broad diversity of diagnoses. As described previously, preoperative exams occurred immediately prior to induction of anesthesia and data from pre-assessment clinic exams were not included.…”