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Point-of-Care Ultrasound in the Preoperative Evaluation of the High-Risk Surgical Patient Requiring Urgent Non-cardiac Surgery

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The High-risk Surgical Patient

Abstract

High-risk surgery is defined as any surgical operation associated with significant inpatient mortality. Despite a considerable research effort, there is still a lack of validated risk assessment tools in the emergency surgery setting. Emergency surgery carries a higher risk of postoperative morbidity and mortality, due to the disadvantage of being generally exerted on physiologically deranged individuals, with limited preoperative information and within a short management timeframe. Point-of-care ultrasound (PoCUS) consists of bedside ultrasonography used in order to get qualitative answers (e.g., “yes” or “no”), applied in multiple settings and performed by the provider in real-time.

PoCUS is gaining popularity among clinicians also for perioperative management. Its minimal invasivity, cost-effectiveness and rapidity of the clinical answers given bedside, makes PoCUS an ideal technique for preoperative evaluation of patients requiring urgent surgery. POCUS must be considered as a clinical decision-making tool capable not only of providing diagnostic indications, and of allowing some invasive procedures, but also of integrating these characteristics in a clinical loop of diagnosis–action–evaluation of the effects, in an iterative process. All the components where a protocolized PoCUS approach could play a role in the preoperative evaluation of the high-risk surgical patient undergoing urgent non-cardiac surgery are reviewed throughout this chapter.

The examination of gastric content, the identification and management of the difficult airway, the assessment for causes of respiratory distress, the cardiovascular assessment, and the abdominal evaluation are summarized, including some educational images. Clinical examples are also provided through the chapter, to help the reader understand the pragmatic use of PoCUS in the context of the urgent surgical population.

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Acknowledgements

We would like to thank the entire team of the Cremona Hospital Anesthesia Department for the astonishing resilience demonstrated in the last 2 years of pandemic. We would like to reserve a special thanks to Dr. Villani and Dr. Bonvecchio for their help in taking and selecting the ultrasound images shown in the chapter.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care Medicine, Cremona Hospital, Cremona, Italy

    Enrico Storti & Michele Introna

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  1. Enrico Storti
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  2. Michele Introna
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Correspondence to Enrico Storti .

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Editors and Affiliations

  1. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Paolo Aseni

  2. Divisione di Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo, Pavia, Pavia, Italy

    Antonino Massimiliano Grande

  3. Div. of Emerg. Surg., Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland

    Ari Leppäniemi

  4. Department of Pathophysiology and Transplantation, General Surgery and Trauma Team, University of Milano, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Osvaldo Chiara

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Storti, E., Introna, M. (2023). Point-of-Care Ultrasound in the Preoperative Evaluation of the High-Risk Surgical Patient Requiring Urgent Non-cardiac Surgery. In: Aseni, P., Grande, A.M., Leppäniemi, A., Chiara, O. (eds) The High-risk Surgical Patient. Springer, Cham. https://doi.org/10.1007/978-3-031-17273-1_25

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