Department of Anesthesiology, Resuscitation and Pain Treatment, Vic University Hospital, University of Barcelona, Barcelona, Spain -
Department of Anesthesiology, Resuscitation and Pain Treatment, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Minerva Anestesiol. 2018 Jan;84(1):94-107. doi: 10.23736/S0375-9393.17.12178-4. Epub 2017 Oct 4.
Ultrasound is a portable and safe technology that is increasingly used to assist anesthetic procedures and has been integrated into the routine practice of a wide range of invasive procedures. As a complementary diagnostic tool, publications related to perioperative support other than vascular access and nerve blocks are currently lacking.
Given the growing interest of anesthesiologists in acquisition of knowledge and skills of ultrasound, we propose a systematic review of the diagnosis, decision making or change in perioperative management of non-cardiac surgical patients derived from ultrasound practice. Of 1112 references found in electronic databases, 62 studies resulted from the screening process.
A complete critical reading of 19 full-text publications was carried out with quantitative analysis of 1825 ultrasound examinations including echocardiography, neck and laryngeal ultrasound, pulmonary ultrasound and abdominal ultrasound, all of them performed by anesthesiologists. Diagnosis applied ultrasound and decision making during perioperative period resulted in change in the management of 31% with 95% CI of 21.06 to 42.04 and odds ratio of 2.68 (1.77 to 4.06) related to hemodynamic, airway and respiratory perioperative management.
Since most of the articles included in this review are observational studies with inherent design concerns, there is an urgent requirement for randomized controlled trials in this area. As anesthesiologists become more comfortable and knowledgeable in ultrasound applied to the perioperative support, emergence of protocols with multidisciplinary ultrasound exploration is expected to allow an improvement in perioperative safety.
超声是一种便携且安全的技术，越来越多地用于辅助麻醉程序，并已整合到广泛的侵入性程序的常规实践中。作为一种补充性诊断工具，目前缺乏与血管通路和神经阻滞以外的围手术期支持相关的出版物。
鉴于麻醉师对获取超声知识和技能的兴趣日益浓厚，我们提出了一项系统评价，旨在从超声实践中诊断、决策或改变非心脏手术患者的围手术期管理。在电子数据库中发现的 1112 条参考文献中，有 62 项研究是通过筛选过程得出的。
对 19 篇全文出版物进行了全面的批判性阅读，并对包括超声心动图、颈部和喉部超声、肺部超声和腹部超声在内的 1825 次超声检查进行了定量分析，这些检查均由麻醉师进行。围手术期应用超声诊断和决策导致 31%的管理发生变化，95%置信区间为 21.06 至 42.04，相关的血流动力学、气道和呼吸围手术期管理的优势比为 2.68（1.77 至 4.06）。
由于本综述中包含的大多数文章都是具有固有设计问题的观察性研究，因此该领域迫切需要随机对照试验。随着麻醉师在超声应用于围手术期支持方面越来越舒适和熟练，多学科超声探索的协议的出现有望提高围手术期安全性。
