2. Department of Anesthesiology, Division of Trauma Anesthesiology, Division of Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
3. Department of Surgery, Division of Trauma and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Background: Hemodynamic monitoring is essential in emergent noncardiac surgery. The majority of reports investigate the use of transesophageal echocardiography with beneficial results. However, this requires expertise and is associated with complications. The use of an intraoperative diagnostic cardiac ultrasound is noninvasive and can provide real-time information, in the intraoperative period, and assist in decision-making by anesthesiologists especially during hemodynamic instability.
Methods: This retrospective case series of six (6) patients describes the utility of a diagnostic intraoperative cardiac ultrasound, performed by anesthesiologists, in emergent noncardiac surgical patients. The ultrasound consisted of four standard windows: the parasternal long axis (PLA), parasternal short axis (PSA), apical (AP) and sub-xyphoid (SX) views. These views were used to assess basic findings including left ventricular function, right atrial function, right ventricular function, and overall volume status and volume responsiveness.
Results: This case series included six emergent noncardiac surgical patients, including trauma, general, neurosurgical and orthopedic patients. The patients were between the ages of 29 to 87 years old with an equal distribution of males and females. Information from the cardiac ultrasound exams were used to assist in decisions for induction of anesthesia, level of resuscitation, inotropic or vasopressor initiation and etiology of cardiac arrest.
Conclusion: A diagnostic cardiac ultrasound is a rapid non-invasive tool that, when used by experienced anesthesiologists, provide real-time information that help guide intraoperative patient care and may ultimately improve outcome.
Keywords: Intraoperative care, diagnostic cardiac ultrasound, emergent noncardiac surgery, hemodynamic monitoring