Ultrasound for the Anesthesiologists

1. DR Mohsen Abad
Pain specialist
Ultrasound for the
Anesthesiologists:
Present and Future
IN THE NAME OF GOD

2. Ultrasound for the
Anesthesiologists
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3. Ultrasound for the
Anesthesiologists
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4. overview
• Introduction
• regional anesthesia
• Neuraxial and Chronic Pain Procedures
• Vascular Access
• Airway Assessment
• Lung Ultrasound
• Neuroultrasound
• Gastric Ultrasound
• Focused Transthoracic Echo (TTE)
Ultrasound for the
Anesthesiologists
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Slides:103

5. Introduction
 Anesthesiologists require quick and accurate
diagnostic tools for the effective management of
emergencies
 Ultrasound (US) is a safe, easily accessible point-of-
care imaging modality
 US being increasingly adopted in modern
anesthesiology practice
 it is important to assure that anesthesiologists are
aware of the expanding applications of this
technology and the status of its use
Ultrasound for the
Anesthesiologists
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6. Current and potential future applications of US
regional
anesthesia
neuroaxial
and chronic
pain
procedures
vascular
access
airway
assessment
lung
ultrasound
21
3 4 5
Ultrasound for the
Anesthesiologists
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7. Current and potential future applications of US
ultrasound
neuro-
monitoring
focused
transthoracic
echo (TTE)
transesophageal
echo (TEE)
and Doppler
87 9
Ultrasound for the
Anesthesiologists
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8. purpose
awareness of
limitations in
various
settings
remain alert for
the development
of US techniques
that are a focus
of ongoing
research
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Anesthesiologists
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9. Regional Anesthesia
most popular ultrasound application
used by anesthesiologists.
gold standard for regional anesthesia
regional anesthesia more accurately
ability to block smaller nerves
more difficult anatomic locations
Ultrasound for the
Anesthesiologists
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10. Regional Anaesthesia
advantages
direct
observation
of the
nerves
surrounding
structures
direct
observation
of local
anesthetic
spread
faster
onset
21
3 4
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Anesthesiologists
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11. Regional Anaesthesia
advantages
improves
block
quality
allows dose
reduction
Safety
In
children
76 8
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Anesthesiologists
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longer
duration
5

12. Neuraxial and Chronic Pain
Procedures
• commonly used modality in the
performance of chronic pain
interventions
• substitute for CT scans and
fluoroscopy in many chronic pain
procedures
Ultrasound for the
Anesthesiologists
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Chronic
Pain

13. current and potential applications of US
Ultrasound for the
Anesthesiologists
neuraxial blocks
nerve root blocks (e.g., cervical and lumber);
stellate ganglion block
lumber transforaminal injections for radicular pain
facet joint block
13
Chronic
Pain

14. current and potential applications of US
intra-articular joint injections
US guidance for peripheral nerve stimulator
implantation
lumber transforaminal injections for radicular pain
interventional procedures for patients with chronic pelvic
pain (e.g., pudendal neuralgia, piriformis syndrome , and
“border nerve” syndrome).
Ultrasound for the
Anesthesiologists
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Chronic
Pain

15. Neuraxial and Chronic Pain Procedures
• US can aid in neuraxial blocks in two ways:
US-assisted neuraxial technique
real-time US-guided neuraxial technique.
Ultrasound for the
Anesthesiologists
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Chronic
Pain

16. Neuraxial and Chronic Pain Procedures
• Identification of landmarks
• estimating epidural space depth,
• facilitating epidural catheter insertion
• epidural catheter placement in children below six years
Ultrasound for the
Anesthesiologists
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Nerve root blocks under US guidance can
be as effective as those placed using a
fluoroscopy-guided method
Chronic
Pain

17. Ultrasound for the
Anesthesiologists
17
Juxtamedian plane in cross-
section and longitudinal scan in
juxtamedian plane

18. Ultrasound for the
Anesthesiologists
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Scan of
facet joints
at L3 and
L4//////

19. Neuraxial and Chronic Pain Procedures
Ultrasound-guided transforaminal injection
• accurate and feasible
• ability in the pre clinical setting,
• advantage over traditional fluoroscopy or CT
scan technique by avoiding radiation
exposure
• ability to be performed as an outpatient
procedure
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Anesthesiologists
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Chronic
Pain

20. Neuraxial and Chronic Pain Procedures
Ultrasound-guided facet joint block
• a minimal invasive procedure,
• with less time consumed,
• lower expenses,
• and fewer complications, in comparison
with fluoroscopy-guided technique
Ultrasound for the
Anesthesiologists
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Chronic
Pain

21. Neuraxial and Chronic Pain Procedures
Ultrasound-guided epidural blood
patch
• allows confirmation of proper
placement of injectate into the
epidural space
Ultrasound for the
Anesthesiologists
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Chronic
Pain

22. Neuraxial and Chronic Pain Procedures
US guidance of intra-articular joint injections
• (mainly the knee joint) improves needle placement
• injection accuracy in comparison with
palpation/anatomic landmark techniques,
• which improves patient-reported clinical outcomes
• cost-effectiveness
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Anesthesiologists
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Chronic
Pain

23. Neuraxial and Chronic Pain Procedures
Ultrasound guided interventional procedures for
patients with chronic pelvic pain
• pudendal neuralgia,
• piriformis syndrome,
• Border nerve syndrome
•Ilioinguinal nerve
•Iliohypogastric nerve
•Genitofemoral nerve
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Anesthesiologists
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Chronic
Pain

24. Ultrasound for the
Anesthesiologists
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Scan of
ilioinguinal
and
iliohypogastric
nerves

25. Vascular Access
• identification of the vein
• detection of variable anatomy
• intravascular thrombosis
• Avoidance of inadvertent arterial puncture
• safer and less time consuming than the traditional
landmark technique
• patients with underlying coagulopathy or platelet
dysfunction
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Anesthesiologists
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26. Vascular Access
• Detection of post procedural
pneumothorax, as an alternative
to chest radiography
• helped in challenging patient
positions: in sitting patients,
patient with kyphosis and fixed
chin-on-chest deformity , and in
the prone position
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Anesthesiologists
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27. Vascular Access
suggested a new 4-
dimensional imaging (real-time
3-dimensional imaging)
approach, using a matrix
arrays transducer, for central
venous cannulation, which
shows promising results in
preventing “overshooting” the
needle and provides better
visualization of anatomy.
Ultrasound for the
Anesthesiologists
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28. Vascular Access
• Peripheral vascular access in pediatrics can be
very challenging especially in small, obese, or
dehydrated children or in those with previously
failed venipuncture
• high-frequency (50MHz) micro-ultrasound (HFMU)
may allow better visualization for the sub-10mm
space. This could be a valuable tool for difficult
vascular access in pediatric patients
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Anesthesiologists
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29. Airway
Assessment
visualize with US
tongue
oropharynx
hypopharynx
epiglottis
Larynx & vocal cords
cricoid cartilage
cricothyroid membrane
trachea
Cervical esophagus
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Anesthesiologists
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NOT Visualize with US
posterior pharynx
Posterior commissure,
posterior wall of the trachea

30. current and potential applications of US
1) prediction of difficult airway
2) confirmation of proper endotracheal tube placement and
ventilation
3) prediction of obstructive sleep apnea
4) airway related nerve blocks
5) prediction of size of endotracheal, endobronchial, and
tracheostomy tubes
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Anesthesiologists
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31. current and potential applications of US
6) assessing and guidance for proper
percutaneous dilatational tracheostomy (PDT);
7) evaluation of airway pathologies :
(e.g., subglottic hemangiomas and stenosis)
8) mandate urgent securing of airway
(e.g., Epiglottitis);
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Anesthesiologists
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32. Prediction of the difficult airway
Anterior soft neck
tissue thickness at the
level of the hyoid
bone
measured the
distance from the skin
to the anterior
aspect of the airway
at the level of the
vocal cords, anterior
to the thyroid cartilage
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Anesthesiologists
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33. Confirmation of proper endotracheal tube
placement
• real-time ultrasound probe
placed transversely on the neck
at the level of the suprasternal
notch during intubation to
observe whether the tube enters
the trachea or esophagus.
direct
• indirect method is by observing
bilateral lung sliding with
ventilation as the probe is placed
in the midaxillary line
indirect
Ultrasound for the
Anesthesiologists
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34. Confirmation of proper endotracheal tube
placement
Fiadjoe et al introduced :
• (without laryngoscope) the tracheal tube containing
a malleable stylet until it was visualized by
ultrasound at the glottis level and then further
adjusted the position and direction into the glottis
until widening of the vocal cords was observed
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Anesthesiologists
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35. acute epiglottitis
• visualized the “P sign” in
a longitudinal view
through the thyrohyoid
membrane
• significant difference in
the anteroposterior
diameter of the epiglottis
in acute epiglottitis
patients
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Anesthesiologists
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“Alphabet P sign” formed by acoustic
shadow of hyoid bone (HY), swollen
epiglottis (pointed by white arrows)

36. obstructive sleep apnea
• tongue base width
• lateral parapharyngeal
wall thickness
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Anesthesiologists
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37. Ultrasound for the
Anesthesiologists
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38. Ultrasound for the
Anesthesiologists
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39. choice of endotracheal tube
• choice of the appropriate
size of endotracheal tube
• US is successfully
improving the performance
of airway related nerve
blocks: superior laryngeal
nerve block
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Anesthesiologists
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40. Ultrasound for the
Anesthesiologists
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The probe is placed under the
submandibular area in a
longitudinal orientation
Post injection sonography.
(1) Superior border of the thyroid cartilage.
(2)Greater horn of the hyoid bone.
(3) Thyrohyoid muscle.
(4) Thyrohyoid membrane.
(5)Thyroid cartilage lamina

41. Percutaneous dilatational tracheostomy (PDT)
• identification of possible vessels in the field
• localization of the midline
• tracheal rings for optimal inter cartilaginous
space selection
• distance from the skin to the surface of the
trachea can also be measured in order to
estimate the required length of the puncture
cannula
Ultrasound for the
Anesthesiologists
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42. Prediction of successful extubation
• long-term
intubated
• have a high risk of
airway edema
• vocal cord injuries
• e.g., after thyroid
surgery
• A pilot study by Ding
et al.
• air-column width
during cuff deflation at
the level of the
cricothyroid
membrane is a
potential predictor of
post extubation
Ultrasound for the Anesthesiologists 42

43. MR Jiang et al :
cranio-caudal displacement of
the liver and spleen with a cut-
off value of 1.1 cm during
spontaneous breathing trials,
measured by ultrasonography,
is a good predictor for
extubation outcome

44. Laryngeal ultrasound
• useful adjunct to
endoscopy in diagnosis of
vocal cord palsy
• Although endoscopy is still
considered the gold
standard for diagnosis of
vocal cord palsy,
• the noninvasive nature
and portability make
ultrasound a good
screening tool pre- and
post thyroidectomy
• Shaath et al:
• accuracy of US in
detection the vocal cord
mobility in children after
cardiac surgery in
comparison with standard
fiber-optic laryngoscopy
• a sensitivity of 100% and
specificity of 80% in 10
patients with persistent
• significant upper airway
obstruction.
Ultrasound for the Anesthesiologists 44

45. Linear transducer was
placed transversely on
the midline of the
cricothyroid membrane
Vocal cords are
abducted on
inspiration
Ultrasound for the
Anesthesiologists
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SM: strap muscles;
TC: thyroid cartilage;
AC: anterior commissure;
PC: posterior commissure;
VC:vocal cords

46. Linear transducer was
placed transversely on
the midline of the
cricothyroid membrane
adducted
partially during
expiration
Ultrasound for the
Anesthesiologists
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SM: strap muscles;
TC: thyroid cartilage;
AC: anterior commissure;
PC: posterior commissure;
VC:vocal cords

47. Linear transducer was
placed transversely on
the midline of the
cricothyroid membrane
are tightly closed
when asking the
patient to say
“Eeeee.”
Ultrasound for the
Anesthesiologists
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SM: strap muscles;
TC: thyroid cartilage;
AC: anterior commissure;
PC: posterior commissure;
VC:vocal cords

48. Lung Ultrasound
• In a number of emergency situations:
• Hypoxia
• Neumothorax
• pulmonary edema
• pulmonary embolism
• ARDS
• ultrasound can be an important tool for diagnosis
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Anesthesiologists
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49. • introduced a quick and
accurate US protocol
(BLUE protocol) for a
rapid diagnosis and
differentiating the
cause of acute
respiratory failure in
critical care settings
• a similar protocol could
possibly be applied to
our anesthetized
patients
• Lung US has a higher
diagnostic yield than
CXR for most of
conditions
• easier
• less time consuming
Ultrasound for the Anesthesiologists 49
Lichtenstein et al.

50. current and potential applications of lung US
diagnosis of pneumothorax
diagnosis of interstitial syndrome
diagnosis and differentiation of underlying cause of Pleural effusion
selecting the optimal puncture site for pleuro centesis;
diagnosis of atelectasis
Ultrasound for the Anesthesiologists 50

51. current and potential applications of lung US
Ultrasound for the Anesthesiologists 51
diagnosis of pulmonary edema and differentiate it from
(ARDS);
diagnosis of pulmonary embolism
monitoring of lung disease (severity, progress, and response to
therapy);
optimizing mechanical ventilation.

52. LUNG US
• choice for detecting pleural line
abnormalities
A high frequency
(7.5 to 10MHz)
• diagnose pleural effusions and
lung parenchymal abnormalities
lower frequency
(3.5MHz) convex
and microconvex
• virtual interplay of two elements:
air and fluid.
B- and M-mode
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Anesthesiologists
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53. Normal Lung
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Anesthesiologists
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“Lung sliding” signs are sliding of visceral and
parietal layers of pleura with respiration
Seashore sign is a complex picture of parallel
lines signifying the static thoracic wall and
sandy “granulous” pattern, which reflect the
normal pulmonary parenchyma.
A-lines are a basic artifact of normally aerated
lung

54. Ultrasound for the
Anesthesiologists
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55. Ultrasound for the
Anesthesiologists
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56. Ultrasound for the
Anesthesiologists
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57. Pneumothorax
Ultrasound for the
Anesthesiologists
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Absence of lung sliding,
presence of lung point.
absence of B-lines
absence of lung pulse
Lung ultrasound rules out the diagnosis of pneumothorax more
accurately than a supine anterior chest X-ray (evidence level A).

58. In a critically ill
supine patient,
air tends to
accumulate
in the anterior
portion of the
thorax
The diagnosis is
made by
detecting the
absence of
the lung tissue
movement
beneath the
pleural line
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Anesthesiologists
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59. Lung Sliding is absent .
100% sensitivity
• No lung sliding on B
Mode
• Seashore sign on M
Mode is replaced by the
Stratosphere sign (no
sand, all sea)
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Anesthesiologists
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60. A localized transition point from
intrapleural air (pneumothorax artifact) to
the interparanchymal air is 100% specific
for pneumothorax
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Anesthesiologists
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The transition from the
seashore sign to the
stratosphere sign on the M
Mode

61. Lung Consolidation
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Anesthesiologists
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Sonographic signs are
a subpleural echo-
poor region or one
with tissue-like
echotexture
Note:
Lung ultrasound can
differentiate between
consolidation of
pulmonary
embolism,
pneumonia, and
atelectasis (evidence
level A).

62. Pleural Effusion
Ultrasound for the
Anesthesiologists
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A hypoechoic or
anechoic space
between
Sono anatomical
boundaries (i.e., chest
wall, the diaphragm
and sub diaphragmatic
organs).
Note:
Lung ultrasound is
more accurate than
chest X-ray
(evidence level A)

63. Pulmonary embolism
peripheral, triangular, and pleural based hypoechoic lesion
• Mathis et al. in a multicenter study that involves 352
patients: defined diagnostic criteria as:
• (1) PE confirmed: two or more typical triangular or rounded
pleural-based lesions
• (2) PE probable: one typical lesion with pleural effusion
• (3) PE possible: small (<5 mm) subpleural lesions or a
single pleural effusion only.
• The sensitivity was 74%, specificity 95%,
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Anesthesiologists
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64. Pulmonary embolism
lung ultrasound)
peripheral,
triangular, and
pleural based
hypoechoic lesions
(yellow arrows);
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Anesthesiologists
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65. Pulmonary embolism
transthoracic echo, apical
view
• right ventricular (RV)
dilation,
• RV hypokinesia,
• septal flattening,
• tricuspid regurgitation
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Anesthesiologists
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IVS:
interventricular septum;
TV: tricuspid valve;
LV: left ventricle;
RA: right atrium;
LA: left atrium.

66. Normal lung ultrasound
2D “red arrows” point to
the pleura, where the
normal “sliding sign”
should be seen
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Anesthesiologists
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while the “yellow
arrows” represent the
A-lines that are normal
reverberation from the
pleura

67. M-mode shows the
“seashore sign.”
Pneumothorax
Ultrasound for the
Anesthesiologists
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68. 2D;
absence of lung
sliding,
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Anesthesiologists
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69. M-mode; “stratosphere
sign” or “barcode sign,”
lung point may also be
seen during inspiration and
represents
the border between
pneumothorax and normal
pleura
Ultrasound for the
Anesthesiologists
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70. Cardiac pulmonary
edema: homogeneous
distribution of B-lines
(yellow arrows),
normal sliding, and no
spared areas
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Anesthesiologists
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71. ARDS
“patchy” distribution of B-
lines, reduced/abolished
sliding, spared areas,
and peripheral
consolidations.
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Anesthesiologists
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72. LUNG US
• US can help in optimizing PPV to achieve the
maximum benefit in oxygenation while avoiding its
side effects on cardiac function
• PEEP can be titrated up and followed by
quantifying the number of B-lines while watching
RV filling and assuring that this PEEP is not causing
any decrease in RV filling.
• Thus chest ultrasound (lung and cardiac US)
evaluation can guide both ventilator and circulatory
support
Ultrasound for the Anesthesiologists 72

73. Current and potential applications of
neuroultrasound
optic nerve sheath diameter (ONSD)
measurement
transcranial Doppler ultrasound
(TDU);
pupillary light reflex (PLR).
Ultrasound for the Anesthesiologists 73

74. optic nerve sheath diameter (ONSD)
Ultrasound for the Anesthesiologists 74
as an increase in ICP will be transmitted
through the subarachnoid space that
surrounds the optic nerve
recent systematic review and meta-analysis
ONSD measurements exhibited a pooled
sensitivity of 0.90 and specificity 0.85
Soldatos et al. found that 5.7mm is a cut-off
value
for elevated ICP with sensitivity of 74.1% and
specificity of 100%

75. optic nerve sheath diameter (ONSD)
Ultrasound for the Anesthesiologists 75
Dubost et al. found that median ONSD values
were significantly greater in preeclamptic
patients at delivery
Dubost et al. in a preliminary report of 10
patients with lumbar epidural blood patch
(EBP) for postdural puncture headache
found that successful EBP was followed by
ONSD enlargement.

76. Ultrasound for the
Anesthesiologists
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77. Ultrasound for the
Anesthesiologists
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normal diameter large diameter that represents increase
intracranial pressure

78. pupillary light reflex
Ultrasound for the Anesthesiologists 78
US assessment of the pupillary light reflex
(PLR) was initially developed for the U.S.
Space Program (NASA)
 PLR test can be conducted with a linear array
probe at the highest available frequency (e.g.,
12–15MHz), using the coronal primary view ,
while M-mode measurements are used to
measure the constriction velocity of the PLR

79. Ultrasound for the
Anesthesiologists
79
diameter of the pupil before shining
light to the contralateral eye
the pupil constricted after shining the light

80. Transcranial color coded duplex (TCCD)
Ultrasound for the Anesthesiologists 80
an accurate, real-time, noninvasive (permits
bedside examination), and inexpensive tool
used for the study of the intracranial
circulation and the diagnosis of non
thrombosed aneurysms, largely due to its
ability to reveal flow phenomena
TCCD has advantages over transcranial
Doppler (TCD) by showing the images of the
intracranial anatomy and arteries throughout
duplex B-mode, while still having the capacity
to measure velocities using Doppler

81. Transcranial color coded duplex (TCCD)
Ultrasound for the Anesthesiologists 81
TCCD can be used for monitoring of cerebral
blood flow alterations which follow traumatic
brain injury
It also can be used in the detection of patent
foramen ovale and in the diagnosis of cerebral
circulatory arrest which is a component of
brain death

82. Ultrasound for the
Anesthesiologists
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middle cerebral artery (MCA) color
Doppler and MCA pulsed wave Doppler

83. Gastric Ultrasound
• full stomach may lead to aspiration
pneumonia
• prandial status, and even fasting “
sufficient ” time cannot guarantee an
empty stomach in many cases :
elderly or gastroparesis
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Anesthesiologists
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84. Current and potential applications of
Gastric ultrasound
assessment of gastric
content and diagnosis of full
stomach;
confirmation of gastric tube
placement
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Anesthesiologists
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85. Gastric Ultrasound
• Bouvet et al:
• measured the antral cross-sectional area (CSA)
in 180 patients after intubation and analyzed the
relationship between antral CSA and the volume
of gastric contents
• The cut-off value of antral CSA of 340mm2 for
the diagnosis of “at risk” stomach was ssociated
with a sensitivity of 91% and a specificity of
71%.
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Anesthesiologists
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86. Gastric Ultrasound
• Perlas et al:
• performed gastric US in 86 patients before induction
• classified using a 3-point grading system:
• grade 0 (empty antrum);
• grade 1 (minimal fluid volume detected only in the right
lateral decubitus position (16 +/− 36 mL, within normal
ranges expected for fasted patients);
• grade 2 (antrum clearly distended with fluid visible in
both supine and lateral positions (180 +/− 83 mL, beyond
previously reported “safe” limits)
• They concluded that this grading system could be a
promising “biomarker” to assess periop aspiration risk.
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Anesthesiologists
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87. Gastric Ultrasound
• Confirmation of a
gastric tube placement
is also possible using
ultrasound which
might replace the
conventional
radiography method
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Anesthesiologists
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88. Ultrasound for the
Anesthesiologists
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Start in the supine position
Follow with the right lateral decubitus (RLD).
Never call an empty stomach based on the supine
position alone

89. Ultrasound for the
Anesthesiologists
89
Blue line: scanning plane;
A: antrum;
Ao: aorta;
L: liver;
P: pancreas;
Sma: superior mesenteric
artery

90. Sonographic image of the gastric antrum of an empty stomach.
P. Van de Putte, and A. Perlas Br. J. Anaesth. 2014;113:12-
22
© The Author [2014]. Published by Oxford University Press on behalf of the British Journal of
Anaesthesia. All rights reserved. For Permissions, please email:
journals.permissions@oup.com
Ultrasound for the
Anesthesiologists
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91. Ultrasound for the
Anesthesiologists
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1: serosa; 2: muscularis propriae; 3: submucosa;
4: muscularis mucosa; 5: mucusal air interface

92. Focused Transthoracic Echo (TTE)
• Focus assessed transthoracic echo (FATE)
was introduced by Jensen et al
• for cardiopulmonary monitoring in ICU
• basically involves 4 standardized acoustic
views for cardiopulmonary screening and
monitoring
• Recent studies show a great impact of FATE
in preoperative assessment
• significantly alters perioperative management
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Anesthesiologists
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93. Ultrasound for the
Anesthesiologists
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left parasternal long axis Apical 4 chamber
Basic transthoracic echo views

94. Ultrasound for the
Anesthesiologists
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Subcostal view
Basic transthoracic echo views

95. Ultrasound for the
Anesthesiologists
95
left parasternal short axis
Basic transthoracic echo views
aortic valve“Mercedes sign,”
mitral valve “fish mouth sign,”
and papillary muscles (two arrows),
respectively, from left to right

96. Focused Transthoracic Echo (TTE)
• Learning the basic skills to perform FATE
allows assessing the global function of the
heart and diagnosing certain pathologies (e.g.,
pulmonary embolism).
• suggested that implementation of a focused
bedside TTE curriculum within anesthesia
residency training is feasible, quantifiable, and
effective for increasing anesthesia residents’
TTE knowledge
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Anesthesiologists
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97. Focused Transthoracic Echo (TTE)
• Recent studies show that preop excess testing
and consultation are common, adding to the
cost of care without noticeably improving
patient outcome.
• These findings must encourage
anesthesiologists to play an effective role in
the preop assessment field by implementing
clinically innovative approaches and
developing training curricula as well as
performing research
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Anesthesiologists
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98. Technological Advances
• matrix array is a new transducer with improved
resolution
• it has a lens that is placed in front of the
piezoelectric element to allow a mechanical
focusing in the Y- and Z-planes
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• Four-dimensional ultrasound provides real-time
3D images (the 4th “D” is time) and currently is
used for fetal imaging,

99. Technological Advances
• mobile ultrasound guided peripheral nerve block
has been developed
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Anesthesiologists
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• SonixGPS needle guidance system (Ultrasonix,
Richmond,BC, Canada) is a GPS technology
with a new needle tracking system, using
sensors in both the needle and transducer to
obtain a real-time image of needle shaft and tip
position related to the us beam that is based on
the needle trajectory.,

100. Conclusion
• Ultrasound is a unique tool which optimization of
perioperative management
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• We believe that ultrasound can be the third eye
of the anesthesiologist that helps in the
performance of previously blind procedures and
allows discovery of many hidden spaces to
uncover their mysteries

101. Conclusion
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• Anesthesiologists, in the near future, may need
to carry a portable ultrasound around their neck
instead of a stethoscope.

102. Ultrasound for the
Anesthesiologists
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Conclusion
• Ultrasound is a unique tool which
optimization of perioperative management

103. Ultrasound for the
Anesthesiologists
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