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Journal of Anesthesia

, Volume 33, Issue 3, pp 435–440 | Cite as

Perioperative point of care ultrasound in pediatric anesthesiology: a case series highlighting real-time intraoperative diagnosis and alteration of management augmenting physical examination

  • Adam C. AdlerEmail author
  • Arvind Chandrakantan
  • Frederick T. Conlin
Special Article

Abstract

Use of diagnostic point of care ultrasound, has come to the forefront of interest within anesthesiology. Much data on the use of point of care ultrasound in emergency medicine and critical care medicine for diagnosis and treatment in acute situations exists. While use of point of care ultrasound has become more prevalent in anesthesia practice, documentation of its use and especially alteration in management based on real-time ultrasound findings in the perioperative period remains scarce. This case series discusses six pediatric patients in which real-time intra-operative use of point of care ultrasound resulted in alteration of management.

Keywords

Ultrasound Point of care ultrasound Perioperative Pediatric Cardiac Transthoracic 

Notes

Author contributions

ACA: study design, data analysis, manuscript preparation and direct patient care. This author has approved the final manuscript. AC: study design and manuscript preparation. This author has approved the final manuscript. FTC: study design and manuscript preparation. This author has approved the final manuscript.

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

Video 1: Lung ultrasound highlighting normal lung sliding followed by appearance of a lung pulse demonstrating a lung segment that is not being ventilated. (MP4 22426 kb)

Video 2: Parasternal short axis view identifying dyskinesia of the left ventricle anterolateral wall and hypokinesia of the anterior and anteroseptal segments with preserved ejection fraction. (MP4 71831 kb)

Video 3: Parasternal short axis view identifying left ventricle antero-septal wall hypokinesis as well as the brief period of absent cardiac activity coinciding with electrocardiographic asystole. (MP4 73269 kb)

Video 4: Subcostal 4 chamber view demonstrating the large pleural effusion with collapsed lung segment. Additional view reveals the paradoxical motion of the atrial septum. (MP4 15740 kb)

References

  1. 1.
    Song IK, Kim EH, Lee JH, Kang P, Kim HS, Kim JT. Utility of perioperative lung ultrasound in pediatric cardiac surgery: a randomized controlled trial. Anesthesiology. 2018;128:718–27.CrossRefPubMedGoogle Scholar
  2. 2.
    Adler AC, Greeley WJ, Conlin F, Feldman JM. Perioperative anesthesiology ultrasonographic evaluation (PAUSE): a guided approach to perioperative bedside ultrasound. J Cardiothorac Vasc Anesth. 2016;30:521–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Adler AC. Perioperative point-of-care ultrasound in pediatric anesthesiology: a case series highlighting intraoperative diagnosis of hemodynamic instability and alteration of management. J Cardiothorac Vasc Anesth. 2018;32:1411–4.CrossRefPubMedGoogle Scholar
  4. 4.
    Adler AC, Jablonka DH. Bedside ultrasound: a tool for assessment of iv functionality. Anesthesiology. 2016;124:959.CrossRefPubMedGoogle Scholar
  5. 5.
    Spencer KT, Anderson AS, Bhargava A, Bales AC, Sorrentino M, Furlong K, Lang RM. Physician-performed point-of-care echocardiography using a laptop platform compared with physical examination in the cardiovascular patient. J Am Coll Cardiol. 2001;37:2013–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Kutty S, Attebery JE, Yeager EM, Natarajan S, Li L, Peng Q, Truemper E, Hammel JM, Danford DA. Transthoracic echocardiography in pediatric intensive care: impact on medical and surgical management. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2014;15:329–35.Google Scholar
  7. 7.
    Canty DJ, Royse CF, Kilpatrick D, Bowman L, Royse AG. The impact of focused transthoracic echocardiography in the pre-operative clinic. Anaesthesia. 2012;67:618–25.CrossRefPubMedGoogle Scholar
  8. 8.
    Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr Off Publ Am Soc Echocardiogr. 2013;26:567–81.CrossRefGoogle Scholar
  9. 9.
    Adler AC. Cardiac ultrasound: it's not just for cardiologists! J Cardiothorac Vasc Anesth. 2016;30:e58–e5959.CrossRefPubMedGoogle Scholar
  10. 10.
    Collins RT II. Cardiovascular disease in Williams syndrome. Circulation. 2013;127:2125–34.CrossRefPubMedGoogle Scholar
  11. 11.
    Burch TM, McGowan FX Jr, Kussman BD, Powell AJ, DiNardo JA. Congenital supravalvular aortic stenosis and sudden death associated with anesthesia: what's the mystery? Anesth Analg. 2008;107:1848–54.CrossRefPubMedGoogle Scholar
  12. 12.
    Kounis NG, Soufras GD, Mazarakis A. The mystery of sudden death in Williams–Beuren syndrome: cardiomyopathy or Kounis syndrome? Int J Cardiol. 2012;156:251–2.CrossRefPubMedGoogle Scholar
  13. 13.
    Soliman OI, van der Beek NA, van Doorn PA, Vletter WB, Nemes A, van Dalen BM, ten Cate FJ, van der Ploeg AT, Geleijnse ML. Cardiac involvement in adults with Pompe disease. J Intern Med. 2008;264:333–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Kimura BJ. Point-of-care cardiac ultrasound techniques in the physical examination: better at the bedside. Heart (British Cardiac Society). 2017;103:987–94.Google Scholar
  15. 15.
    Adler AC, Schwartz ER, Waters JM, Stricker PA. Anesthetizing a child for a large compressive mediastinal mass with distraction techniques and music therapies as the sole agents. J Clin Anesth. 2016;35:392–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Via G, Hussain A, Wells M, Reardon R, ElBarbary M, Noble VE, Tsung JW, Neskovic AN, Price S, Oren-Grinberg A, Liteplo A, Cordioli R, Naqvi N, Rola P, Poelaert J, Guliĉ TG, Sloth E, Labovitz A, Kimura B, Breitkreutz R, Masani N, Bowra J, Talmor D, Guarracino F, Goudie A, Xiaoting W, Chawla R, Galderisi M, Blaivas M, Petrovic T, Storti E, Neri L, Melniker L. International Liaison Committee on Focused Cardiac UltraSound (ILC-FoCUS); International Conference on Focused Cardiac UltraSound (IC-FoCUS). International evidence-based recommendations for focused cardiac ultrasound. J Am Soc Echocardiogr Off Publ Am Soc Echocardiogr. 2014;27:683e1–683e33CrossRefGoogle Scholar
  17. 17.
    Jensen MB, Sloth E, Larsen KM, Schmidt MB. Transthoracic echocardiography for cardiopulmonary monitoring in intensive care. Eur J Anaesthesiol. 2004;21:700–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Conlin F, Connelly NR, Eaton MP, Broderick PJ, Friderici J, Adler AC. Perioperative use of focused transthoracic cardiac ultrasound: a survey of current practice and opinion. Anesth Analg. 2017;125:1878–82.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2019

Authors and Affiliations

  1. 1.Department of Anesthesiology, Perioperative and Pain MedicineTexas Children’s Hospital, Baylor College of MedicineHoustonUSA
  2. 2.Department of Anesthesiology, Baystate Medical CenterUniversity of MassachusettsSpringfieldUSA

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