Perioperative Ultrasound Training in Anesthesiology: A Call to Action

Mahmood, Feroze; Matyal, Robina; Skubas, Nikolaos J.; Montealegre-Gallegos, Mario; Swaminathan, Madhav; Denault, André; Sniecinski, Roman; Mitchell, John D.; Taylor, Mark A.; Haskins, Stephen C.; Shahul, Sajid; Oren-Grinberg, Achikam; Wouters, Patrick; Shook, Douglas C.; Reeves, Scott

doi:10.1213/ane.0000000000001134

Cited by 114 publications

(72 citation statements)

References 95 publications

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“…The integration of basic TEE training into the residency curriculum [33] should be considered to offer the full potential of this tool to the next generation of providers [23, 34]. …”

Section: Where Are We?mentioning

confidence: 99%

“…More recently, specific perioperative scanning protocols have been proposed [22], and extensive reviews have advocated the need for anesthesiologists to perform perioperative POCUS [23]. Editorials in major anesthesia journals in the USA [24–26] and Canada [27] have clearly indicated that POCUS is the tool of the future in perioperative medicine.…”

Section: Introductionmentioning

confidence: 99%

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POCUS in perioperative medicine: a North American perspective

Marchi

Meineri

2017

Crit Ultrasound J

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Ultrasound (US) performed at the point of care has found fertile ground in perioperative medicine. In the hands of anesthesiologists, transesophageal echocardiography (TEE) has become established as a powerful diagnostic and monitoring tool in the perioperative care of cardiac and non-cardiac patients. A number of point-of-care US (POCUS) applications are relevant to perioperative care, including airway, cardiac, lung and gastric US. Although guidelines exist to define the scope of practice for basic and advanced TEE, there remains a lack of such guidelines for perioperative point-of-care ultrasound (POCUS), despite a number of recent calls for action in the academic anesthesia community. POCUS training has been integrated into anesthesia residency curricula in Canada and the United States of America (USA). However, a nation-wide curriculum is still lacking. Many limitations to the development of perioperative POCUS curricula exist, including the need to define the scope of practice and design integrated longitudinal learning approaches. The main anesthesiologist societies in both the USA and Canada are promoting the development of guidelines and have introduced POCUS courses into their national conferences. Although bedside US imaging has been integrated into the curricula of many medical schools in North America, the need for specific national guidelines for the training and practice of POCUS in the perioperative setting by anesthesiologists is crucial to the further development of POCUS in perioperative medicine.

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“…The integration of basic TEE training into the residency curriculum [33] should be considered to offer the full potential of this tool to the next generation of providers [23, 34]. …”

Section: Where Are We?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

POCUS in perioperative medicine: a North American perspective

Marchi

Meineri

2017

Crit Ultrasound J

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“…In a recent position paper, a multidisciplinary task force reviewed the expanding scope of perioperative ultrasound and called to action for it to be made an essential component of the anaesthesia curriculum and to be embraced by anaesthetists [15]. Although not devoid of individual challenges, conquering the task should come naturally to the regional anaesthetist already familiar with principles of procedural ultrasound, making the outlook achievable in the foreseeable future.…”

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confidence: 99%

Ultrasound applications for regional anaesthetists – thinking outside the box

Iohom

2018

Med Ultrason

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Deposition of local anaesthetic in the proximity of nerves, plexi, within fascial planes, in the paravertebral, epidural or subarachnoid space, is the ever expanding core activity of a regional anaesthetist. Advantages of using ultrasound in this clinical setting include detection of anatomic variants, reduction of volume of local anaesthetic needed with the implication of a lower potential for systemic toxicity, faster onset, real-time assessment of needle advancement avoiding key structures such as blood vessels or pleura, and observation of local anaesthetic spread patterns, all of which are key elements of block success and safety [1]. In addition, we have developed approaches aimed at reducing or quantifying side effects, such as sparing the phrenic nerve when performing an interscalene block [2,3] or assessing the degree of the resulting diaphragm paralysis [4].From the preoperative to the postoperative period, there appear to be many more opportunities for ultrasound users to improve patient assessment and management in the ultimate hope of improved perioperative outcomes.Recent guidelines on vascular access recommend the use of ultrasound guidance for all routes of access where the vessel cannot be directly seen or palpated [5]. Routine use of ultrasound had been previously documented for internal jugular central venous catheterisation (unless in emergency or other unusual situations), and early in other procedures (arterial and peripheral venous), if difficult. Clearly, ultrasound makes many steps safer including: evaluation of puncture site, eliminating seeker needles, needle guidance, verification of guidewire/catheters in a vessel, information on central catheter tip position and recognition of complications [5].As an emerging application, ultrasound has been shown to aid airway evaluation and management with obvious potential benefits for both clinician and patient. Ultrasound can identify vocal cord dysfunction and pathology before induction of anaesthesia thus highlighting potential difficulties. It may be utilized to determine airway size and predict the appropriate diameter of single-and double-lumen endotracheal tubes as well as tracheostomy tubes [6]. It appears to reliably differentiate between tracheal, oesophageal, and bronchial intubation. Taken a step forward, ultrasonography of the neck can accurately locate the cricothyroid membrane for emergency airway access and identify tracheal rings for ultrasound-guided tracheostomy. Upper airway point-ofcare ultrasound has thus the potential to become the firstline non-invasive adjunct assessment tool in airway management [6].Much has been published in recent years on the utility of ultrasound for evaluation of gastric content. Inhalation of gastric content during induction, maintenance or emergence from anaesthesia has devastating consequences leading to significant morbidity and mortality. Therefore, evaluation of gastric contents is most helpful in order to inform an assessment of aspiration risk and thus guide anaesthetic management at the be...

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“…Indeed, echocardiography is so ubiquitous in anesthesia practice that many think it should be a fundamental cognitive skill taught to all anesthesiology trainees during residency. 1,2 Thanks to its access to multiple acoustic windows, surface ultrasound can evaluate many organ systems other than the heart, leading to the everyday use of ''point of care ultrasound'' (POCUS) in many perioperative diagnostic situations, as well as in the intensive care unit and the emergency department. With POCUS, we can examine the inferior vena cava (IVC), liver, spleen, kidneys, bladder and, of particular importance to anesthesiologists, the lungs and pleural spaces.…”

mentioning

confidence: 99%