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Focused Cardiac Ultrasound for the Regional Anesthesiologist and Pain Specialist

Haskins, Stephen C. MD*; Tanaka, Christopher Y. MD; Boublik, Jan MD, PhD; Wu, Christopher L. MD§; Sloth, Erik MD, PhD∥**

doi: 10.1097/AAP.0000000000000650
Regional Anesthesia and Acute Pain: Review Articles

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.

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.

Accepted for publication April 30, 2017.

Address correspondence to: Stephen C. Haskins, MD, Department of Anesthesiology, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 (e-mail:

E.S. is the co-owner of and creator of the FATE (Focus Assessed Transthoracic Echocardiography) card. The other authors declare no conflict of interest.

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Copyright © 2017 by American Society of Regional Anesthesia and Pain Medicine.