ANAESTHESIA AND PATIENT MONITORING
Point-of-care ultrasound Guiding regional anaesthesia is a major application of point-of-care ultrasound. Other applications have also been developed, such as guiding difficult intubations, or selective intubations for thoracic surgery.
In general, we only use regional anaesthesia in isolation for localised limb procedures, although it may sometimes be used to treat other surgical procedures (breast, thoracic, abdominal: thoracic and abdominal wall, epidural space, para-vertebral blocks) or chronic pain in hospitalised patients following thoracotomy or other major surgery. The combined use of regional and general anaesthesia is common in thoracic and abdominal surgery, for example, for investigating the perimedullary space. This last point is important to help avoid misplacement of punctures using a ‘blind’ approach; ultrasound allows a reduction in the number of punctures. A total of 65% of our patients have ambulatory surgery, the others are urgent cases or need to stay in hospital because of a major procedure, or due to the presence of several comorbidities. Long-term perineal catheter placement may be an effective strategy for testing or reducing chronic pain. Ultrasound makes it possible to optimise the positioning of the catheter and to secure it with respect to the adjacent vascular structures. Young doctors in training during their six-month internship with our team participate in ultrasound demonstrations to improve the basic techniques learned during their university studies. Our role
Point-of-care ultrasound is used to answer complex questions about patient care
Young doctors in training during their six-month internship with our team participate in ultrasound demonstrations to improve the basic techniques learned during their university studies.
as experienced anaesthetists is to supervise and help them to apply this knowledge in real-life situations. Our teaching is not limited to regional anaesthesia, and includes all point-of- care procedures. We also teach them the order in which to follow a procedure so that nothing is missed or goes wrong. The three FUJIFILM SonoSite S-Nerve devices are used daily and valued for their simplicity of use and quick start-up, their mobility, their robustness and their efficiency, as well
as for the 2D modality, time- movements and Doppler function. We are often called to go to
emergency or intensive care to evaluate a patient who is difficult to mobilise, and the devices give a real ‘point-of- care’ solution. They are ideally suited to the TUBE protocols we perform; we are convinced that this approach will rapidly become a medical necessity. Currently more than 50% of our patients benefit from point-of-care ultrasound as part of a general clinical evaluation.
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Currently more than 50% of the hospital’s patients benefit from point-of-care ultrasound as part of a general clinical evaluation
OPERATING THEATRE l JULY 2018 l 51
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