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Point-of-care ultrasound for the pediatric regional anesthesiologist and pain specialist: a technique review
  1. Michelle S Kars1,
  2. Andrea Gomez Morad2,
  3. Stephen C Haskins3,
  4. Jan Boublik4 and
  5. Karen Boretsky5
  1. 1Department of Anesthesiology, Steven and Alexandra Cohen Children’s Medical Center, New Hyde Park, New York, USA
  2. 2Department of Anesthesiology Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
  3. 3Department of Anesthesiology, Hospital for Special Surgery, New York, New York, USA
  4. 4Department of Anesthesiology, Stanford Hospital and Clinics, Stanford, California, USA
  5. 5Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Michelle S Kars, Anesthesiology, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York, USA; mkars{at}northwell.edu

Abstract

Point-of-care ultrasound (PoCUS) has been well described for adult perioperative patients; however, the literature on children remains limited. Regional anesthesiologists have gained interest in expanding their clinical repertoire of PoCUS from regional anesthesia to increasing numbers of applications. This manuscript reviews and highlights emerging PoCUS applications that may improve the quality and safety of pediatric care.

In infants and children, lung and airway PoCUS can be used to identify esophageal intubation, size airway devices such as endotracheal tubes, and rule in or out a pulmonary etiology for clinical decompensation. Gastric ultrasound can be used to stratify aspiration risk when nil-per-os compliance and gastric emptying are uncertain. Cardiac PoCUS imaging is useful to triage causes of undifferentiated hypotension or tachycardia and to determine reversible causes of cardiac arrest. Cardiac PoCUS can assess for pericardial effusion, gross ventricular systolic function, cardiac volume and filling, and gross valvular pathology. When PoCUS is used, a more rapid institution of problem-specific therapy with improved patient outcomes is demonstrated in the pediatric emergency medicine and critical care literature.

Overall, PoCUS saves time, expedites the differential diagnosis, and helps direct therapy when used in infants and children. PoCUS is low risk and should be readily accessible to pediatric anesthesiologists in the operating room.

  • pediatrics
  • critical care
  • emergency care
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Footnotes

  • Twitter @mkarsmd, @shaskinsMD, @janboublik MDPhD

  • Contributors MSK and KB designed and implemented the project. MSK, AGM, SCH, JB and KB wrote the manuscript. MSK and KB formatted and edited the manuscript. All authors were involved in revisions for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study. Data sharing not applicable.

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