Perioperative focused cardiac ultrasound: a brief report

BACKGROUND: The anesthesiologist's emerging role as a perioperative physician has challenged the field to broaden its scope of practice to meet the demands of the patient undergoing surgery today. This brief report aims to identify the indications, clinical impact on management decisions, and perioperative focused cardiac ultrasound accuracy in patients scheduled for non-cardiac surgery. METHODS: A review from the Department of Anesthesia Perioperative Echocardiography database on transthoracic echocardiography was performed, including clinical, demographic, indications, therapeutic impact, and accuracy from February 1, 2017 to October 10, 2019. RESULTS: A total of 220 FoCUS exams were identified. FoCUS was performed in 55% males and 45% females. The average age was 66.5 years, and 68% of patients were designated ASA 3 classification. The majority underwent thoracic procedures with a history of cardiovascular disease for hemodynamic instability in the post-anesthesia care unit (PACU). In this group, 94% had a change in management. New findings in 9 patients resulted in pre-induction management change. FoCUS was also performed intraoperatively to differentiated hemodynamic instability, significantly altering care. Postoperatively, new wall motion abnormalities findings escalated care to the cardiology service. Immediate assessment of hemodynamic instability altered care and postoperative recovery location in a significant number of patients. In all cases, FoCUS was used to guide management in the differential diagnosis of the acute event and to assess treatment response. CONCLUSION: This review demonstrates that FoCUS is an excellent clinical adjunct in the perioperative period. Diagnostic accuracy and efficiency by pattern recognition helped answer clinically significant questions and guide management. The non-invasive approach of POCUS and its rapid adaptation makes it an exciting area of future research.