Brian Cowie1. 1. Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria, Australia. brian.cowie@svhm.org.au
Abstract
OBJECTIVES: The aim of this study was to assess the feasibility and effects on perioperative management of a focused transthoracic echocardiogram performed by anesthesiologists. DESIGN: A prospective observational study of all patients having a focused cardiovascular ultrasound (FoCUS). SETTING: A single tertiary referral university teaching hospital. PARTICIPANTS: Fifty consecutive perioperative patients who had a clinical indication for a FoCUS. INTERVENTIONS: After performing a FoCUS, relevant clinical information was communicated to the anesthesiologist in charge of the case, who then decided on the appropriate management of the patient including the choice of anesthesia, invasive monitoring, fluids, vasoactive drugs, and postoperative care. If indicated, patients were referred for a formal cardiology-based transthoracic echocardiogram. MEASUREMENTS AND MAIN RESULTS: Anesthesiologists were able to obtain diagnostic-quality images during a FoCUS in 98% of patients. The most common indication for a FoCUS was an undifferentiated ejection systolic murmur in 50% of cases, with 38% of all patients having aortic stenosis. In 84% of patients, some change in their perioperative care occurred as a result of the FoCUS study. Major findings correlated with a formal cardiology-based transthoracic echocardiogram in 87% of cases. CONCLUSION: Anesthesiologists with a cardiac and echocardiography background can successfully perform a FoCUS in almost all patients when indicated, which provides valuable new diagnostic information guiding changes in perioperative management in the majority of patients.
OBJECTIVES: The aim of this study was to assess the feasibility and effects on perioperative management of a focused transthoracic echocardiogram performed by anesthesiologists. DESIGN: A prospective observational study of all patients having a focused cardiovascular ultrasound (FoCUS). SETTING: A single tertiary referral university teaching hospital. PARTICIPANTS: Fifty consecutive perioperative patients who had a clinical indication for a FoCUS. INTERVENTIONS: After performing a FoCUS, relevant clinical information was communicated to the anesthesiologist in charge of the case, who then decided on the appropriate management of the patient including the choice of anesthesia, invasive monitoring, fluids, vasoactive drugs, and postoperative care. If indicated, patients were referred for a formal cardiology-based transthoracic echocardiogram. MEASUREMENTS AND MAIN RESULTS: Anesthesiologists were able to obtain diagnostic-quality images during a FoCUS in 98% of patients. The most common indication for a FoCUS was an undifferentiated ejection systolic murmur in 50% of cases, with 38% of all patients having aortic stenosis. In 84% of patients, some change in their perioperative care occurred as a result of the FoCUS study. Major findings correlated with a formal cardiology-based transthoracic echocardiogram in 87% of cases. CONCLUSION: Anesthesiologists with a cardiac and echocardiography background can successfully perform a FoCUS in almost all patients when indicated, which provides valuable new diagnostic information guiding changes in perioperative management in the majority of patients.