What will the practice of anesthesiology be like in 2026? Will propofol-administering robots be involved in every endoscopy and colonoscopy? Will one anesthesiologist be supervising 20 nurse anesthetists all at once? Will the practice of anesthesiology be even relevant in ten years, as other physicians are now learning how to sedate and intubate? These questions are extraordinarily difficult to answer, with many differing opinions depending on whom you ask.
One thing is certain, however. The future of anesthesia practice must involve the use of point-of-care ultrasound.
When I graduated from residency in 2012, we used the ultrasound machine for two procedures: central line placement and peripheral nerve blocks. In 2016, however, it is abundantly clear that ultrasound can have other, immensely valuable perioperative applications. Ultrasound machines have been rapidly shrinking in size; the newest models can fit in a white coat or scrub pocket. As the machines have been getting smaller, the indications for point-of-care ultrasound have been increasing.
Papers in the May, 2015 issue of Anesthesia & Analgesia have illustrated the utility of point-of-care ultrasound for a variety of uses:
- Bladder scanning for urinary retention
- Assessment of gastric volume
- Transthoracic examination for ventricular and valvular function
- Diagnosis of pneumothorax and pleural effusions
- Endotracheal tube location.
Many of us may be familiar from medical school with the “FAST” exam: Focused Assessment with Sonography for Trauma. A novel algorithm, FORESIGHT (Focused, PeriOperative Risk Evaluation Sonography, Involving Gastro-Abdominal, Hemodynamic, and Trans-Thoracic Ultrasound) may be helpful for perioperative assessment. More information can be found at www.FORESIGHTultrasound.com.
Along with these new perioperative indications for ultrasound, there is an increasing need to incorporate these principles into residency education. The graduating anesthesia resident will be asked to engage in perioperative management, and knowledge of ultrasound can be immensely valuable to their future practices. As our own practice has moved from the “landmark technique” for central venous access to ultrasound as the “gold standard”, point-of-care ultrasound will become the gold standard for preoperative optimization as well as for intraoperative and postoperative diagnosis and management. Residency programs should consider integration of an ultrasound curriculum into their core didactics, to better prepare their residents for the future ahead.
For those already in practice, it can be difficult to learn a new skill. However, with the new importance of providing value-based care, acquisition of novel techniques and changes in practice are necessities. Online-based learning at www.FORESIGHTultrasound.com can be helpful. Live instruction, however, can help fine-tune skills. Many workshops focus primarily on perioperative transthoracic and transesophageal echocardiography.
For those who wish to take their training a step further, the Loma Linda University Department of Anesthesiology and the UCLA Department of Anesthesiology and Perioperative Medicine are hosting a Perioperative Point-of-Care and Cardiac Ultrasound Workshop next month in Santa Monica. The workshop has two tracks: perioperative point-of-care ultrasound, and basic echocardiography.
The perioperative point-of-care ultrasound track will contain workshops on pulmonary and airway ultrasound, as well as assessment of gastric volume, intravascular volume status, and regional anesthesia. The echocardiography track will review basic valvular and ventricular function, and the utility of transesophageal echocardiography outside of the operating room. The workshop will be held from September 24-25, 2016 at the Loews Santa Monica Beach Hotel. More information can be found here.
Regardless of how ultrasound is incorporated into your practice, there is one certainty: it must be added to our cadre of skills for us to expand our value and relevance as perioperative physicians.