Point of care ultrasound for the clinical anesthesiologist

Perioperative gastric ultrasound: utility and limitations

“…In contrast, gastric contents will primarily sit within the gastric body and the fundus when patients are supine. Positioning patients in the RLD position improves the operator’s ability to detect small gastric volumes 17. Some patients, however, will not be able to be placed into the RLD position, and the examination may be performed in the semirecumbent or supine position 9,17.…”

“…When selecting the proper transducer for gastric ultrasound, the operator must take the patients age and size into consideration. For most adults and children weighing more than 40 kg, a low-frequency curvilinear probe is ideal, whereas a high-frequency linear probe will be best suited for pediatric patients or thin adults 17. Curvilinear transducers produce ultrasound waves in the 2 to 5 MHz range, a lower frequency than linear transducers, which generally produce ultrasound waves in the 5 to 15 MHz range.…”

“…2A, C). The operator will then slide the transducer laterally from the left to right along the subcostal margin until the vascular landmarks are identified 17. In most patients, the gastric antrum can be identified overlying the aorta and superior mesenteric artery just to the right of the patient’s midline (Figs.…”

“…Once the aorta and superior mesenteric artery are identified, additional rocking of the transducer in a heel-to-toe manner may be necessary to place the gastric antrum in the center of the screen. Further image optimization may be achieved by adjusting the image depth, gain, and focal zone as necessary 17. Care must be taken to avoid scanning too far laterally, as the gastric pylorus may be mistaken for an empty antrum.…”

Point-of-Care Ultrasound (POCUS) for the Cardiothoracic Anesthesiologist

“…Varying aspects of nearly all organ systems can be evaluated using POCUS (see Table 1), and there are increasingly more clinical conditions in which the utilization of POCUS may have a role. 3,4 In particular, this growth has been accelerated further with the availability and accessibility of small handheld ultrasound devices. In certain clinical contexts (eg, pneumothorax [PTX], hemidiaphragmatic paresis), POCUS has superior diagnostic sensitivity and specificity compared to other diagnostic modalities, while also mitigating the higher costs and possible radiation side effects of non-ultrasound imaging.…”