Uses of Ultrasound in Anesthesiology
92 likes11,192 views
Ultrasound is increasingly integrated into anesthesiology for improved diagnostic and monitoring capabilities, enhancing patient management in emergencies and various procedures. Its applications include regional anesthesia, vascular access, airway assessment, and lung ultrasound, minimizing complications and optimizing care. Technological advancements have made ultrasound machines more accessible and effective, positioning this tool as essential for the future of anesthesiologists' practice.
Uses of Ultrasound in Anesthesiology
- 1. Ultrasound probe in the hands of Anesthesiologist
- 2. Ultrasound imaging simple and noninvasive technique to provide a more accurate clinical assessment and localization of area of interest Modern ultrasound machines are more compact and portable, with better resolution and enhanced tissue penetration for identification and desired intervention in various body structures Introduction
- 3. Introduction
- 4. Anesthesiologists require quick and accurate diagnostic tools for the effective management of emergencies. Ultrasound (US) is a safe, easily accessible point-of- care imaging modality that is being increasingly adopted in modern anesthesiology practice. Introduction
- 5. As physician-performed ultrasound becomes more practical and practiced, it is important to assure that anesthesiologists are aware of the expanding applications of this technology and the status of its use. Introduction
- 6. Regional anesthesia Vascular access Focussed Transthoracic Echo (TTE) Transesophageal echo (TEE) and Doppler Lung ultrasound Airway assessment Ultrasound neuromonitoring Current and potential future applications
- 7. Ultrasound for Regional Anesthesia
- 8. Ultrasound has become a commonly used modality in the performance of chronic pain interventions and has begun to substitute for CT scans and fluoroscopy in many chronic pain procedures. It allows direct visualization of tissue structure while allowing real-time guidance of needle placement and medication administration. Neuraxial and Chronic Pain Procedures
- 9. Nerve root blocks Stellate ganglion blocks transforaminal injections for radicular pain intra-articular joint injections Neuraxial and Chronic Pain Procedures
- 10. Vascular Access
- 11. Ultrasound imaging indicates the presence, patency, position, and direction of vessels Advantages identification of the vein detection of variable anatomy and intravascular thrombi avoidance of inadvertent arterial puncture Vascular Access
- 12. This may be particularly useful in hemodialysis patients, high-risk and difficult patients who need large- bore dual lumen catheters, present for repeated cannulation, may not be able to lie supine, and may have underlying coagulopathy or platelet dysfunction Valves and thrombi can also be located Vascular Access
- 13. Ultrasound can also be used for localization of central vein catheters and detection of postprocedural pneumothorax, as an alternative to chest radiography Vascular Access
- 14. Ultrasound-guided vascular access has helped in various challenging patient positions: in sitting patients patient with kyphosis and fixed chin-on-chest deformity in the prone position Vascular Access
- 15. Ultrasound arterial cannulation reducing the number of attempts shortening the procedure time increasing the success rate, even in children A linear or hockey-stick probe can be used Vascular access
- 16. Marked reduction in complication rates after implementation of US-guided central venous cannulation approaches. Although some complications still happen, rates of 4.6% have been reported, comparing with 10.5% when using landmark technique, which represents an absolute risk reduction of 5.9% Vascular Access
- 17. Peripheral vascular access in pediatrics can be very challenging especially in small, obese, or dehydrated children or in those with previously failed venipuncture. Vascular Access
- 19. Airway ultrasound can visualize and assess the tongue, oropharynx, hypopharynx, epiglottis, larynx, vocal cords, cricothyroid membrane, cricoid cartilage, trachea, and cervical esophagus. The posterior pharynx, posterior commissure, and posterior wall of the trachea cannot be visualized due to artifacts that are created by the intraluminal air column Airway Assessment
- 20. prediction of difficult airway evaluation of airway pathologies • that may affect the choice of airway management (e.g., subglottic hemangiomas and stenosis), or mandate urgent securing of airway (e.g., Epiglottitis) confirmation of proper endotracheal tube placement and ventilation Current and potential applications of airway ultrasound
- 21. prediction of size of endotracheal, endobronchial, and tracheostomy tubes assessing and guidance for percutaneous dilatational tracheostomy (PDT) prediction of successful extubation •(a) prediction of airway edema;(b) assessment of the diaphragm movement; (c) assessment of vocal cord movements Current and potential applications of airway ultrasound
- 22. Current and potential applications of airway ultrasound Ultrasound is successfully improving the performance of airway related nerve blocks, including superior laryngeal nerve, deep cervical plexus, alveolar nerve, and superficial trigeminal nerve.
- 23. Current and potential applications of airway ultrasound Although endoscopy is still considered the gold standard for diagnosis of vocal cord palsy, the noninvasive nature and portability make ultrasound a good screening tool pre- and postthyroidectomy.
- 24. Lung Ultrasound
- 25. In a number of emergency situations, hypoxia will require urgent and appropriate diagnosis for its management Pneumothorax, pulmonary edema, pulmonary embolism, and ARDS are situations where ultrasound can be an important tool for diagnosis However, it has some limitations when used in patients with subcutaneous emphysema, pleural calcifications, and in the obese Lung Ultrasound
- 26. diagnosis of pneumothorax diagnosis of pulmonary consolidation and pneumonia diagnosis of atelectasis diagnosis of pulmonary embolism Current and potential applications of lung ultrasound
- 27. diagnosis and differentiation of underlying cause of Pleural effusion selecting the optimal puncture site for pleurocentesis monitoring of lung disease (severity, progress, and response to therapy) optimizing mechanical ventilation Current and potential applications of lung ultrasound
- 29. Ultrasound is useful in assessing elevated ICP and cerebral perfusion Current and potential applications of neuro- ultrasound are: optic nerve sheath diameter (ONSD) measurement transcranial Doppler ultrasound (TDU) pupillary light reflex (PLR) Ultrasound Neuromonitoring
- 30. An increase in ICP will be transmitted through the subarachnoid space that surrounds the optic nerve within its sheath and has been proposed as noninvasive and reliable means of assessing ICP in neurocritically ill patients Optic Nerve Sheath Diameter (ONSD) measurement
- 31. Transcranial color coded duplex (TCCD) is an accurate, real-time, noninvasive (permits bedside examination), and inexpensive tool used for the study of the intracranial circulation and the diagnosis of nonthrombosed aneurysms, largely due to its ability to reveal flow phenomena Transcranial color doppler
- 32. TCCD can be used for monitoring of cerebral blood flow alterations which follow traumatic brain injury and in patients with sickle cell anemia. It also can be used in the diagnosis of cerebral circulatory arrest which is a component of brain death Transcranial color doppler
- 33. Ultrasound assessment of the pupillary light reflex
- 34. Ultrasound assessment of the pupillary light reflex M-mode measurements are used to measure the constriction velocity of the PLR. This method might be used as pupillometry as well
- 36. A full stomach may lead to aspiration pneumonia and subsequent morbidities Anesthesiologists may encounter patients with unknown prandial status, and even fasting “sufficient” time cannot guarantee an empty stomach in many cases e.g., in the elderly or in patients with gastroparesis Ultrasound can help in this setting, and the perioperative evaluation of bowel motility is also feasible by means of sonography Gastric Ultrasound
- 37. Current and potential applications of Gastric ultrasound are: assessment of gastric content and diagnosis of full stomach confirmation of gastric tube placement Gastric Ultrasound
- 38. Bouvet et al. , measured the antral cross-sectional area (CSA) in 180 patients after intubation and analyzed the relationship between antral CSA and the volume of gastric contents The cut-off value of antral CSA of 340mm2 for the diagnosis of “at risk” stomach was associated with a sensitivity of 91% and a specificity of 71% The area under the receiver operating characteristic (ROC) curve for the diagnosis of “at-risk” stomach was 90% Gastric Ultrasound
- 39. Confirmation of a gastric tube placement is also possible using ultrasound, which might replace the conventional radiography method unless sonography is inconclusive Gastric Ultrasound
- 41. Focus assessed transthoracic echo (FATE) was introduced by Jensen et al. for cardiopulmonary monitoring in the intensive care unit. This approach basically involves four standardized acoustic views for cardiopulmonary screening and monitoring Focused Transthoracic Echo (TTE)
- 42. Focused Transthoracic Echo (TTE)
- 43. Focused Transthoracic Echo (TTE) Focused cardiovascular ultrasound performed by anesthesiologists in the perioperative period accurately detects major cardiac pathology and significantly alters perioperative management
- 45. New technologies have greatly improved the image quality, diagnostic abilities, and size of the US machine These include advances in transducers, scanning schemes, three- and four- dimensional visualization, contrast agents (microbubbles), strain imaging etc Technological Advances
- 46. Four-dimensional ultrasound provides real- time 3D images (the 4th “D” is time) and currently is used for fetal imaging, where it provides remarkable images Endobronchial and endoscopic ultrasounds are two other new modalities with great and potential implications Technological Advances
- 47. Small and portable ultrasound systems have become increasingly available, even a mobile ultrasound- guided peripheral nerve block has been developed Technological Advances
- 48. Summary
- 49. Ultrasound is a unique tool which provides the anesthesiologist with diagnostic and monitoring capabilities enabling optimization of perioperative management Ultrasound-guided anesthetic procedures have given a new life to traditional skills Summary
- 50. Indeed, ultrasound has an important role in problem- based management of various anesthesiology emergencies such as hypoxia, hypotension, dyspnea, and cardiopulmonary arrest Summary
- 51. Finally, procedural ultrasound applications in the field of anesthesiology are numerous and improve the quality of care Ultrasound can be the third eye of the anesthesiologist that helps in the performance of previously blind procedures and allows discovery of many hidden spaces to uncover their mysteries Summary
- 52. Anesthesiologists, in the near future, may need to carry a portable ultrasound around their neck instead of a stethoscope Summary