Why Anesthesiologists Must Incorporate Focused Cardiac Ultrasound Into Daily Practice

Coker, Bradley J; Zimmerman, Josh

doi:10.1213/ane.0000000000001854

Cited by 40 publications

(27 citation statements)

References 27 publications

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“…A MEDLINE search for the terms ''POCUS'', ''point-of-careultrasound'', or ''bedside ultrasound'' showed that only 60 articles were published in 1990 compared with 1,030 in 2016. To facilitate the implementation of POCUS into anesthesia care, there has been strong advocacy for its integration into residency and postgraduate training, 5,38,46,65,[67][68][69][70][71][72] with convincing evidence that POCUS is a skill that can be readily acquired at all levels of training. 5,11,46,47,69,73 Despite the numerous applications, great potential for patient care, and recent growth in the use of POCUS in anesthesia, there are still barriers that prevent it from being a current standard practice and challenges in establishing anesthesia-specific guidelines.…”

Section: Résumémentioning

confidence: 99%

Acquiring and maintaining point-of-care ultrasound (POCUS) competence for anesthesiologists

McCormick

Miller

Chen

et al. 2018

Can J Anesth/J Can Anesth

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Presently, our specialty requires consensus by expert stakeholders to address issues of competence, certification, development of standards and terminology, and the management of unexpected diagnoses. To promote POCUS competency in our discipline, we support its incorporation into anesthesiology curricula and training programs and the continuing professional development of POCUS-related activities at a national level.

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Section: Résumémentioning

confidence: 99%

Acquiring and maintaining point-of-care ultrasound (POCUS) competence for anesthesiologists

McCormick

Miller

Chen

et al. 2018

Can J Anesth/J Can Anesth

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“…[4] A comprehensive TTE examination involves the use of specific equipment, assists with diagnosing pathology, and requires a larger knowledge base with specialised training. FOCUS as a screening modality has a more focused scope, and is used to answer a specific clinical question, often looking for a 'yes' or 'no' answer.…”

Section: Cmementioning

confidence: 99%

“…This application does not require cardiology knowledge, and less intensive training is needed. [4] However, interpretation of the images requires adequate training and is operator dependent. Clinical common sense is also needed to apply the additional echo findings to the clinical scenario.…”

Section: Cmementioning

confidence: 99%

Point-of-care and lung ultrasound incorporated in daily practice

et al. 2018

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Corresponding author: J L C Swanevelder (justiaan.swanevelder@uct.ac.za)Point-of-care ultrasound (POCUS) is a fast-growing clinical utility and is becoming an essential clinical skill for all practitioners attending to critically ill patients. Ultrasound equipment is now smaller, more affordable and readily available in clinical work areas. POCUS is performed by a non-cardiologist physician at the patient's bedside as an adjunct to the physical examination. It is easily taught, non-invasive and allows for real-time clinical information. Bedside use of ultrasound imaging aids with rapid diagnosis of severe and life-threatening pathological conditions. It can be repeated, may change clinical management, and impact on patient outcome. POCUS has a broad clinical use, including, but not limited to, focused assessed transthoracic echocardiography (FATE), lung ultrasound imaging, extended focused assessment with sonography for trauma (e-FAST), vascular access and regional blocks. It may also be extended to detect endotracheal intubation and the estimation of intracranial pressure. Assessment of cardiac pathology by POCUS, performed by a novice examiner, has been shown to compare with the gold standard of an expert. Training is paramount. The physician should know his limitations and always relate the information back to the clinical scenario and context. By incorporating POCUS as part of our armamentarium and into our daily medical practice, we might see it reach its full clinical potential, optimising patient care and improving patient outcomes.

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“…3 In addition, a recent editorial presented evidence in support of the daily use of FoCUS by anesthesiologists, further promoting its potential as the "21stcentury stethoscope." 12,13 In this review, we discuss the role FoCUS has for regional anesthesiologists and pain specialists. We will introduce the regionalist to the normal sonoanatomy of the basic FoCUS views and then use the Indication, Acquisition, Interpretation, and Medical decision making (I-AIM) framework to present the cardiac pathology most relevant to the regional anesthesiologist and pain specialist in the perioperative setting.…”

mentioning

confidence: 99%

Focused Cardiac Ultrasound for the Regional Anesthesiologist and Pain Specialist

Haskins

Tanaka

Boublik

et al. 2017

Regional Anesthesia and Pain Medicine

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This article in our point-of-care ultrasound (PoCUS) series discusses the benefits of focused cardiac ultrasound (FoCUS) for the regional anesthesiologist and pain specialist. Focused cardiac US is an important tool for all anesthesiologists assessing patients with critical conditions such as shock and cardiac arrest. However, given that ultrasound-guided regional anesthesia is emerging as the new standard of care, there is an expanding role for ultrasound in the perioperative setting for regional anesthesiologists to help improve patient assessment and management. In addition to providing valuable insight into cardiac physiology (preload, afterload, and myocardial contractility), FoCUS can also be used either to assess patients at risk of complications related to regional anesthetic technique or to improve management of patients undergoing regional anesthesia care. Preoperatively, FoCUS can be used to assess patients for significant valvular disease, such as severe aortic stenosis or derangements in volume status before induction of neuraxial anesthesia. Intraoperatively, FoCUS can help differentiate among complications related to regional anesthesia, including high spinal or local anesthetic toxicity resulting in hemodynamic instability or cardiac arrest. Postoperatively, FoCUS can help diagnose and manage common yet life-threatening complications such as pulmonary embolism or derangements in volume status. In this article, we introduce to the regional anesthesiologist interested in learning FoCUS the basic views (subcostal 4-chamber, subcostal inferior vena cava, parasternal short axis, parasternal long axis, and apical 4-chamber), as well as the relevant sonoanatomy. We will also use the I-AIM (Indication, Acquisition, Interpretation, and Medical decision making) framework to describe the clinical circumstances where FoCUS can help identify and manage obvious pathology relevant to the regional anesthesiologist and pain specialist, specifically severe aortic stenosis, hypovolemia, local anesthetic systemic toxicity, and massive pulmonary embolism.

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Why Anesthesiologists Must Incorporate Focused Cardiac Ultrasound Into Daily Practice

Cited by 40 publications

References 27 publications

Acquiring and maintaining point-of-care ultrasound (POCUS) competence for anesthesiologists

Acquiring and maintaining point-of-care ultrasound (POCUS) competence for anesthesiologists

Point-of-care and lung ultrasound incorporated in daily practice

Focused Cardiac Ultrasound for the Regional Anesthesiologist and Pain Specialist

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