Focused Cardiac Ultrasound for the Regional Anesthesiologist and Pain Specialist

Stephen C. Haskins, Christopher Y. Tanaka, Jan Boublik, Christopher L. Wu, Erik Sloth

Research output: Contribution to journalReview article

8 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)632-644
Number of pages13
JournalRegional Anesthesia and Pain Medicine
Volume42
Issue number5
DOIs
StatePublished - Sep 1 2017

Fingerprint

Conduction Anesthesia
Pain
Aortic Valve Stenosis
Local Anesthetics
Heart Arrest
Pulmonary Embolism
Point-of-Care Systems
Hypovolemia
Inferior Vena Cava
Standard of Care
Anesthetics
Shock
Anesthesia
Hemodynamics
Anesthesiologists
Learning
Pathology

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Focused Cardiac Ultrasound for the Regional Anesthesiologist and Pain Specialist. / Haskins, Stephen C.; Tanaka, Christopher Y.; Boublik, Jan; Wu, Christopher L.; Sloth, Erik.

In: Regional Anesthesia and Pain Medicine, Vol. 42, No. 5, 01.09.2017, p. 632-644.

Research output: Contribution to journalReview article

Haskins, Stephen C. ; Tanaka, Christopher Y. ; Boublik, Jan ; Wu, Christopher L. ; Sloth, Erik. / Focused Cardiac Ultrasound for the Regional Anesthesiologist and Pain Specialist. In: Regional Anesthesia and Pain Medicine. 2017 ; Vol. 42, No. 5. pp. 632-644.
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