Perioperative Point-of-Care Ultrasound in Children.

Karen Boretsky

doi:10.3390/children7110213

Abstract

Anesthesiologists and other acute care physicians perform and interpret portable ultrasonography—point-of-care ultrasound (POCUS)—at a child’s bedside, in the perioperative period. In addition to the established procedural use for central line and nerve block placement, POCUS is being used to guide critical clinical decisions in real-time. Diagnostic point-of-care applications most relevant to the pediatric anesthesiologist include lung ultrasound for assessment of endotracheal tube size and position, pneumothorax, pleural effusion, pneumonia, and atelectasis; cardiac ultrasound for global cardiac function and hydration status, and gastric ultrasound for aspiration risk stratification. This article reviews and discusses select literature regarding the use of various applications of point-of-care ultrasonography in the perioperative period.

Highlights

IntroductionBedside ultrasound-imaging, point-of-care ultrasound (POCUS), was first introduced into the operating rooms in 1984 as a procedural adjunct to facilitate placement of central intravenous access [1]
Bedside ultrasound-imaging, point-of-care ultrasound (POCUS), was first introduced into the operating rooms in 1984 as a procedural adjunct to facilitate placement of central intravenous access [1].While originally resisted by the anesthesia community, the use of ultrasonography for central line placement has decreased infection rates, decreased the incidence of complications, decreased the time for placement, and increased first-attempt and overall success rate [2,3]
The most common regional anesthetic performed in children is caudal blockade and success rates are increased to 95–100% with ultrasound guidance compared to 79–80% with landmark technique [7,8,9]

Summary

Introduction

Bedside ultrasound-imaging, point-of-care ultrasound (POCUS), was first introduced into the operating rooms in 1984 as a procedural adjunct to facilitate placement of central intravenous access [1]. While originally resisted by the anesthesia community, the use of ultrasonography for central line placement has decreased infection rates, decreased the incidence of complications (pneumothorax and bleeding), decreased the time for placement, and increased first-attempt and overall success rate [2,3]. Ultrasound can be used to verify epidural catheter placement through the acoustic window provided by the incomplete ossification of the infant spine [10,11,12]. This spares additional exposure to radiation otherwise needed for confirmatory epidurograms. The purpose of this article is to describe specific POCUS applications performed on children in the perioperative period and discuss benefits and limitations compared with conventional practice. Children 2020, 7, 213 applications performed on children in the perioperative period and discuss benefits and limitations compared with conventional practice

Lungs and Airway

Gastric

Findings

Conclusions