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Focused Cardiac Ultrasound for the Regional Anesthesiologist and Pain Specialist
  1. Stephen C. Haskins, MD*,
  2. Christopher Y. Tanaka, MD,
  3. Jan Boublik, MD, PhD,
  4. Christopher L. Wu, MD§ and
  5. Erik Sloth, MD, PhD,**
  1. *Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, New York; †Department of Anesthesiology, Montefiore Medical Center; Albert Einstein College of Medicine, New York, NY; ‡Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA; §Department of Anesthesiology, Johns Hopkins University, Baltimore, MD; ∥Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; and **Department of Anesthesiology, University of Cape Town, Cape Town, South Africa
  1. correspondence: Stephen C. Haskins, MD, Department of Anesthesiology, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 (e-mail: haskinss{at}hss.edu).

Abstract

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.

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Footnotes

  • E.S. is the co-owner of USABCD.org and creator of the FATE (Focus Assessed Transthoracic Echocardiography) card. The other authors declare no conflict of interest.

    Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.rapm.org).

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