Recent advances in ultrasound technology have made ultrasound equipment more versatile, portable, and accessible than ever. Modern handheld, ultra-portable ultrasound devices have been developed by multiple companies and are contributing to make bedside ultrasound evaluation a practice available to all physicians. The significance of making point-of-care ultrasound (POCUS) a common practice that all physicians eventually can use in the evaluation of their patients is changing the way medicine is practiced, allowing physicians to quickly obtain valuable information to complement the traditional physical examination. Despite the proven benefits of using bedside ultrasound imaging as a part of the patient evaluation and for procedure guidance, adoption of this technology still is not widespread among anesthesiology clinicians nor is there uniform teaching of ultrasound skills to anesthesia residents and faculty. Among obstacles that have been identified as precluding achievement of the goal of widespread utilization of POCUS among anesthesia professionals and trainees, are the availability of equipment for all physicians when it is needed and lack of instructor supervision for trainees who desire to use ultrasound but do not always have an instructor knowledgeable in POCUS with them when an ultrasound examination is warranted. Herein, the characteristics, advantages, and limitations of available ultra-portable, handheld ultrasound devices are analyzed, with a focus on the Butterfly iQ (Butterfly Network, Inc, Guilford, CT) pocket probe, which is available at the authors' institution, and how some of its features, such as the capacity to emulate multiple transducers and its cloud-sharing and teleguidance technology, may contribute to increase the availability and use of POCUS by anesthesia clinicians.

Sleep-related breathing problems were common in our patients with idiopathic intracranial hypertension. Obesity was common in these patients and may be playing a causative role in sleep apnea and idiopathic intracranial hypertension. It is suggested that idiopathic intracranial hypertension patients who have symptoms of sleep disturbance should be further evaluated for the presence of sleep-related breathing problems.

Background: The objective of this study was to evaluate the impact of LAA exclusion on short term outcomes in patients with atrial fibrillation undergoing isolated coronary artery bypass graft (CABG) surgery. Methods: We queried the 2010-2014 National Readmissions Database (NRD) for patients who underwent coronary artery bypass graft repair with and without left atrial appendage ligation using ICD-9 procedure codes (ICD-9: 36.1xx). Only patients with a history of atrial fibrillation were included in our analysis. The primary outcome of our study was 30-day readmissions following discharge. Secondary outcomes were in hospital mortality and stroke. To assess the postoperative outcomes, we utilized multivariate logistic regression models to adjust for clinical and demographic covariates. Results: In total we analyzed 253,287 CABG patients, 7.0% of whom received LAA closure. LAA exclusion was associated with a greater risk of postoperative respiratory failure (8.2% vs. 6.2%, p <.0001), acute kidney injury (21.8% vs. 18.5%, p <.0001), but did not significantly change the rate of blood transfusions or occurrence of cardiac tamponade. LAA exclusion was associated with a non-significant reduction in stroke (7.9% vs. 8.6%, p = .12), no difference in in-hospital mortality (2.2% vs. 2.2% p = .99), and a greater risk of 30-day readmission (16.0% vs. 9.6%, p < .0001) After covariate adjustment, LAA ligation remained a significant predictor of 30-day readmission (OR: 1.640, 95% CI: 1.603 - 1.677, p <.0001). Conclusions: LAA exclusion during isolated CABG in patients with AF is associated with a higher rate of 30-day readmission. Post-operative measures to mitigate the loss of the hormonal and hemodynamic effects of the LAA may increase the therapeutic benefit of this procedure.

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