Article Text
PDF
Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims Point-of-care ultrasound (PoCUS) is important for anesthesiologists, for not only procedures but for diagnosis. Training in PoCUS is compulsory for anesthesiology residents in the USA, but only stipulates focused cardiac and lung. The Focused Assessment with Sonography in Trauma (FAST) exam is a vital tool for anesthesiologists to rule out causes of perioperative hypotension.
Methods We present two cases. First, a patient who underwent elective robotic assisted laparoscopic myomectomy and became hypotensive in the post anesthetic care unit (PACU). A FAST exam revealed a large volume of hypoechoic, intraperitoneal free fluid and the patient was taken back to the operating room for exploration and hysterectomy. Second, during placement of a ventriculoperitoneal shunt for hydrocephalus, a patient rapidly decompensated after insufflation of the abdomen. The arriving anesthesiologists quickly performed focused cardiac and FAST exams, showing that the liver was full of air and suggesting insufflation of the liver on placement of the initial laparoscopic trocar.
Results FAST exams are a critical tool when attempting to quickly diagnose causes of hypotension. Cardiac ultrasound is now generally regarded as an essential tool for anesthesiologists, and FAST should be regarded as equally important. Further, in terms of ultrasound skills needed to perform the FAST exam, it is technically easier than cardiac and only adds 3 additional views.
Conclusions Anesthesiologists should be comfortable performing FAST exams in hemodynamically unstable patients and be able to interpret the images with confidence.
This image was obtained during the FAST exam performed on the first patient mentioned in this case report, showing the spleen floating in a large volume of hypoechoic intraperitoneal free fluid
This image was obtained during the FAST exam performed on the second patient mentioned in this case report, showing the liver with copious hyperechoic gas throughout