Application of ultrasound in Department of anesthesiology
Application of ultrasound in Department of anesthesiology
Medical ultrasound technology was produced in the 1940s, because of its non-invasive, non-radiation and other advantages, doctors and patients favored. With the continuous development of material science, electronic components, AI technology and information technology, ultrasonic imaging technology has developed from one-dimensional to three-dimensional, from qualitative to quantitative, from analog imaging to digital imaging, image quality is getting higher and higher, and ultrasonic equipment has gradually moved from huge size to portability and even miniaturization. At present, ultrasound is not only used in ultrasound department for image diagnosis, but is gradually entering clinical departments, and more and more uses are constantly developed and applied. Today we will talk about the specific applications of ultrasound in the department of anesthesiology:
1. Ultrasound assisted arteriovenous puncture
The use of ultrasound in the Department of Anesthesiology to assist arteriovenous puncture, whether scanning and positioning before puncture, or guiding puncture and catheterization during puncture, has long been recognized as a good method. With the help of ultrasound, the success rate of puncture is increased and the complications are reduced. Meanwhile, ultrasound-guided puncture of axillary vein, brachial vein and noble vein also provides more choices for clinical work. Therefore, other departments and even nursing departments are also actively learning to use ultrasound to assist puncture, or ask anesthesiologists to help when they encounter difficulties.
2. Ultrasound guided nerve block
As a visualization tool, ultrasound not only reduces the blindness of puncture by relying solely on anatomical positioning, but also gradually replaces the discomfort caused by puncture by relying on neurostimulator. Due to the continuous improvement of imaging quality, the anesthesiologist can not only clearly see the tissue structure of blood vessels and nerves, but also display the location of the puncture needle in real time, so that the appropriate puncture path can be selected to avoid accidentally injuring the blood vessels and nerves. The diffusion of the liquid can also be observed during infusion, which not only helps us evaluate the effect of the block, but also reduces the dosage of local anesthetics. TAP block, iliac fascia block, erector spinal block and quadrate lumbar block have been widely used. With the continuous development of ultrasound equipment and people's in-depth understanding of human anatomy, more and more blocking methods have been applied to clinical practice, making the ultrasus-guided nerve block technology become the core technology of anesthesiologists, which greatly enrichis the work of anesthesiologists. From the traditional nerve block in extremity surgery in the past, to the new block methods, such as regional block, fascia block and nerve root block, which are widely used before, during and after surgery, they not only reduce the perioperative pain of patients, increase the satisfaction of patients' medical experience, but also create better conditions for patients' rapid recovery of ERAS and reduce the hospitalization cost of patients.
3. Transesophageal echocardiographyTEE
Preoperative echocardiography has become routine in many cases and is an important means for anesthesiologists to evaluate cardiac function. However, in the rapidly changing conditions of patients during surgery, especially in the treatment of large cardiac vessels and critical patients, anesthesiologists need to know the heart function and cardiac anatomy of patients in real time. At present, transesophageal echocardiography (TEE) is the only monitoring means to obtain real-time and non-invasive cardiac image information, and it can also assess the circulation capacity status of patients. To instruct volume management and the use of vasoactive agents. Intraoperative thrombus can be diagnosed early. However, TEE has high requirements on the operator, and only the correct section can obtain clinically useful information. In 2012, the Chinese Anesthesiologist Intraoperative Transesophageal Ultrasound Collaboration Group was established in West China Hospital, marking a new era of rapid development of intraoperative transesophageal ultrasound technology in China. In the future, more and more anesthesiologists will receive formal training in transesophageal ultrasound, so that the technology can be popularized in more hospitals and benefit more patients.
4. The application of lung ultrasound
In the past, it was thought that the lung was an air-bearing organ and a no-go area for ultrasound applications. The thorax is now considered to be a structure containing gas, water and solid tissue, and any change in their respective proportions will be reflected on ultrasound. In the past, the anesthesiologist in the operating room mainly through the stethoscope to judge the patient's lung disease, now can use the visual "stethoscope" ultrasound to more directly observe the patient's primary lung disease and acute lung complications during the operation. Pulmonary diseases associated with perioperative period mainly include pneumothorax, pulmonary edema and atelectasis. The simultaneous disappearance of the pleural slip sign, pulmonary pulse and B-line can be used to diagnose pneumothorax. In addition, the pulmonary point sign is highly specific for the diagnosis of pneumothorax. The ultrasonography of pulmonary edema shows three or more concomitant B-lines, which are more sensitive than arterial partial oxygen pressure, but lack specificity. Atelectasis is often accompanied by air bronchogram. Ultrasound can also be used to differentiate ARDS from cardiogenic pulmonary edema.
5. Gastric ultrasound assessment of gastric contents
Reflux aspiration is always one of the last things anesthesiologists want to see. Most patients undergoing general anesthesia are able to abstained from food and water according to regulations, but some special patients, including patients undergoing emergency surgery, do not empty the stomach contents. At this time, it is necessary to have an objective indicator to help the anesthesiologist judge the degree of fullness of the stomach in order to develop a reasonable anesthesia program. The anesthesiologist can determine the volume and nature of the patient's stomach contents according to the characteristics of the ultrasound image. Generally, the cross-sectional area of the gastric antrum is measured to evaluate the volume of the stomach contents. The liquid generally presents a low echo shadow, while the solid substance presents a high echo shadow. Corresponding measures, including H2 blockers and rapid induction, can be taken to reduce the incidence of reflux aspiration.
6. Other applications
Today, ultrasound is increasingly used in anesthesiology, including assessing difficult airways, determining whether tracheal tubes have strayed into the esophagus, assisting in locating intraspinal anesthesia, and assessing diaphragm movement
Brief summary
Nowadays, the application of ultrasound in the department of anesthesiology is not only limited to the auxiliary tool of puncture, but also becomes the means of diagnosis and monitoring of anesthesiologists. Its many applications include emergency trauma diagnosis, difficult airway management, respiratory function assessment, cardiopulmonary function monitoring, shock treatment, and assisting surgeons in many areas. As the anesthesiologist's "third eye" will play a broader application prospect.
