Point-of-care ultrasound (POCUS) has become an essential tool in modern medicine, significantly improving the accuracy of diagnostic and therapeutic interventions. Initially popularized in emergency and critical care settings, POCUS now also has applications to anesthesiology and perioperative medicine. Its real-time imaging capabilities, portability, and non-invasive nature make it a valuable resource for clinicians managing complex patient cases in a variety of medical contexts.
One of the primary applications of POCUS in anesthesiology is airway management, particularly during intubation. Esophageal intubation is a serious complication that can lead to significant morbidity and even mortality. Traditional confirmation methods, such as direct visualization or capnography, can be challenging in certain circumstances, such as in patients with difficult airways or low end-tidal CO2 levels during cardiac arrest. POCUS allows clinicians to confirm endotracheal intubation by providing real-time visualization of tracheal dilation as the endotracheal cuff is inflated. In cases of esophageal intubation, the absence of tracheal dilation and lung sliding confirms improper placement (1).
POCUS also has valuable applications in cardiac assessment. In the perioperative setting, rapid assessment of a patient’s cardiac status is critical to the management of hemodynamic instability. Transthoracic echocardiography allows anesthesiologists to quickly assess conditions such as valvular abnormalities, pericardial effusions, and ventricular dysfunction. Cardiac POCUS can detect acute ischemic changes by identifying regional wall motion abnormalities, providing critical information in situations where electrocardiograms (ECGs) may not show significant changes. For example, in patients with intraoperative hypotension, POCUS can detect hypokinesis or akinesis of the ventricular wall, indicating ischemia (2).
Pulmonary ultrasound is another important application of POCUS, offering high accuracy in the diagnosis of respiratory problems such as pneumothorax, pleural effusions, and pulmonary edema. Its sensitivity and specificity for detecting these conditions exceed that of traditional methods such as chest radiography, and it can be performed in real time during surgery or in the intensive care unit. In particular, POCUS is highly effective in detecting pneumothorax, with the absence of lung shift being a clear indicator (3). In addition, it allows for the rapid detection and management of pleural effusions and atelectasis, conditions commonly encountered in the perioperative period (3).
Applications of POCUS also include vascular access guidance. Ultrasound-guided vascular access improves the safety and success rate of procedures such as central venous catheterization, peripheral venous access, and arterial line placement. The real-time imaging provided by POCUS helps clinicians visualize the targeted vessels, reducing the risk of complications such as arterial puncture, hematoma, or pneumothorax. A systematic review found that ultrasound guidance for central venous catheterization reduced the number of complications and improved the overall success rate, especially in patients with difficult vascular anatomy (4).
Finally, one of the most recognized applications of POCUS in anesthesia is in regional anesthesia. Ultrasound-guided nerve blocks have revolutionized the practice of peripheral nerve blocks, allowing anesthesiologists to visualize nerves and surrounding structures with great accuracy. This technique reduces the risk of nerve injury, vascular puncture, and local anesthetic toxicity. By visualizing the needle in real time, clinicians can ensure accurate deposition of anesthetic around the nerve, improving the success rate and reducing the onset time of blocks (5). The superiority of ultrasound-guided nerve blocks over traditional techniques has been demonstrated in multiple studies, confirming its role in improving patient outcomes in both elective and emergency procedures (5).
References
1. Kalagara H, Coker B, Gerstein NS, Kukreja P. Point-of-care ultrasound (POCUS) for the cardiothoracic anesthesiologist. J Cardiothorac Vasc Anesth. 2022.
2. Naji A, Chappidi M, Ahmed A, Monga A, Sanders J. Perioperative point-of-care ultrasound use by anesthesiologists. Cureus. 2021.
3. Haskins SC, Bronshteyn Y, Perlas A, et al. Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists. Reg Anesth Pain Med. 2021;46(12):1031-1036.
4. Li L, Yong RJ, Kaye AD, Urman RD. Perioperative point of care ultrasound (POCUS) for anesthesiologists: an overview. Curr Pain Headache Rep. 2020;24(12):84.
5. Novitch M, Prabhakar A, Siddaiah H, Sudbury AJ. Point of care ultrasound for the clinical anesthesiologist. Best Pract Res Clin Anaesthesiol. 2019;33(3):343-353.