Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Sep 2009
ReviewGoal-directed fluid management with trans-oesophageal Doppler.
Major surgery is associated with significant trauma and is a potential cause of multiple system organ failure and death. Measurement of cardiac output using a variety of techniques during the perioperative period has enabled practitioners to proactively optimise stroke volume and cardiac output in an attempt to reduce postoperative complications. ⋯ Oesophageal Doppler ultrasonography is a minimally invasive method for measuring stroke volume and cardiac output. It is user-friendly and is one of the few low-invasive technologies to date, which has been used successfully to guide intra-operative fluid administration, resulting in improvement in outcome and significant reduction in duration of hospital stay.
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Point-of-care ultrasound is well suited for use in the emergency setting for assessment of the trauma patient. Currently, portable ultrasound machines with high-resolution imaging capability allow trauma patients to be imaged in the pre-hospital setting, emergency departments and operating theatres. In major trauma, ultrasound is used to diagnose life-threatening conditions and to prioritise and guide appropriate interventions. ⋯ Ultrasound can also be used at the bedside to guide procedures in trauma, including nerve blocks and vascular access. Importantly, these examinations are being performed by the treating physician in real time, allowing for immediate changes to management of the patient. Controversy remains in determining the best training to ensure competence in this user-dependent imaging modality.
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Best Pract Res Clin Anaesthesiol · Sep 2009
Historical ArticleTraining guidelines for ultrasound: worldwide trends.
Sound travels through objects that block light. Only very recently has technology advanced enough to decipher ultrasound for medical use. Machines have become smaller, cheaper, more versatile and more advanced than ever before. ⋯ There also needs to be an understanding of when broad experience and advanced technical skills are required or when limited skills will do. In addition, some procedures can be performed more safely with ultrasound where the knowledge of ultrasound is not paramount. This article covers current provision of training in echocardiography and ultrasound in areas relevant to anaesthetists who are working in critical care (including accident and emergency) and complex surgery (mainly cardiac).
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Best Pract Res Clin Anaesthesiol · Sep 2009
ReviewUltrasound-guided nerve blocks: efficacy and safety.
The introduction of affordable, portable and high-resolution ultrasound machines has rejuvenated interest in regional anaesthesia. The inherent benefits of direct visualisation of nerves and surrounding anatomy, continual observation of the needle tip and spread of local anaesthetic make ultrasound-guided regional anaesthesia highly appealing. However, in the cost-conscious health-care setting and to convince sceptics, there also needs to be evidence of increased benefits and reduced complications. ⋯ This article focusses on the recent growing evidence to support the benefits of its use in nerve and plexus blocks. Common complications of nerve blocks can be avoided with ultrasound but have still been reported. Anatomical variants have been demonstrated by ultrasound and it has proved to be useful in performing regional anaesthesia in difficult situations or where peripheral nerve stimulation is unsuccessful or inappropriate.
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Best Pract Res Clin Anaesthesiol · Sep 2009
ReviewEpiaortic ultrasound assessment of the aorta in cardiac surgery.
The dislodgement of atheroma from the ascending aorta and proximal arch is a major cause of stroke and neurological injury following cardiac surgery. The accurate detection of atheroma prior to aortic manipulation is necessary to facilitate surgical strategies to reduce the risk of embolisation. The traditional method for atheroma detection is manual palpation by the surgeon. ⋯ Accurate detection of atheroma requires direct ultrasound assessment using epiaortic scanning, with a high-frequency, linear-array probe. This allows the surgeon to correctly assess and localise any atheroma. In this article, a suggested epiaortic examination sequence is described and strategies for surgeons to avoid atheroma are discussed.