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聚焦式心脏超声在区域麻醉医师和疼痛专家中的应用。

Focused Cardiac Ultrasound for the Regional Anesthesiologist and Pain Specialist.

机构信息

From the *Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, New York; †Department of Anesthesiology, Montefiore Medical Center; Albert Einstein College of Medicine, New York, NY; ‡Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA; §Department of Anesthesiology, Johns Hopkins University, Baltimore, MD; ∥Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; and **Department of Anesthesiology, University of Cape Town, Cape Town, South Africa.

出版信息

Reg Anesth Pain Med. 2017 Sep/Oct;42(5):632-644. doi: 10.1097/AAP.0000000000000650.

Abstract

This article in our point-of-care ultrasound (PoCUS) series discusses the benefits of focused cardiac ultrasound (FoCUS) for the regional anesthesiologist and pain specialist. Focused cardiac US is an important tool for all anesthesiologists assessing patients with critical conditions such as shock and cardiac arrest. However, given that ultrasound-guided regional anesthesia is emerging as the new standard of care, there is an expanding role for ultrasound in the perioperative setting for regional anesthesiologists to help improve patient assessment and management. In addition to providing valuable insight into cardiac physiology (preload, afterload, and myocardial contractility), FoCUS can also be used either to assess patients at risk of complications related to regional anesthetic technique or to improve management of patients undergoing regional anesthesia care. Preoperatively, FoCUS can be used to assess patients for significant valvular disease, such as severe aortic stenosis or derangements in volume status before induction of neuraxial anesthesia. Intraoperatively, FoCUS can help differentiate among complications related to regional anesthesia, including high spinal or local anesthetic toxicity resulting in hemodynamic instability or cardiac arrest. Postoperatively, FoCUS can help diagnose and manage common yet life-threatening complications such as pulmonary embolism or derangements in volume status. In this article, we introduce to the regional anesthesiologist interested in learning FoCUS the basic views (subcostal 4-chamber, subcostal inferior vena cava, parasternal short axis, parasternal long axis, and apical 4-chamber), as well as the relevant sonoanatomy. We will also use the I-AIM (Indication, Acquisition, Interpretation, and Medical decision making) framework to describe the clinical circumstances where FoCUS can help identify and manage obvious pathology relevant to the regional anesthesiologist and pain specialist, specifically severe aortic stenosis, hypovolemia, local anesthetic systemic toxicity, and massive pulmonary embolism.

摘要

这是我们的即时超声系列文章中的一篇,讨论了聚焦心脏超声(FoCUS)对区域麻醉师和疼痛专家的益处。聚焦心脏超声是所有评估危急情况下患者(如休克和心脏骤停)的麻醉师的重要工具。然而,鉴于超声引导下区域麻醉正在成为新的护理标准,超声在围手术期的应用对于区域麻醉师来说有了更大的作用,可以帮助改善患者评估和管理。除了提供有关心脏生理学(前负荷、后负荷和心肌收缩力)的有价值的见解外,FoCUS 还可用于评估有发生与区域麻醉技术相关并发症风险的患者,或改善接受区域麻醉护理患者的管理。在术前,FoCUS 可用于评估患者是否存在严重的瓣膜疾病,如严重的主动脉瓣狭窄或在进行脊麻前容量状态异常。在术中,FoCUS 可帮助区分与区域麻醉相关的并发症,包括高脊髓或局部麻醉毒性导致的血流动力学不稳定或心脏骤停。在术后,FoCUS 可帮助诊断和管理常见但危及生命的并发症,如肺栓塞或容量状态异常。在本文中,我们向有兴趣学习 FoCUS 的区域麻醉师介绍基本视图(肋缘下 4 腔、肋缘下下腔静脉、胸骨旁短轴、胸骨旁长轴和心尖 4 腔)以及相关的超声解剖结构。我们还将使用 I-AIM(适应证、采集、解释和医学决策)框架来描述 FoCUS 可以帮助识别和管理与区域麻醉师和疼痛专家相关的明显病理学的临床情况,特别是严重的主动脉瓣狭窄、低血容量、局部麻醉全身毒性和巨大肺栓塞。

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