Perioperative applications of focused cardiac ultrasound.

Over the past decade, transthoracic cardiac ultrasound as a bedside assessment tool has seen tremendous growth; it is unparalleled in value as a diagnostic modality that is portable and low in cost and risk to the patient. Advances in ultrasound technology and a growing body of scientific evidence supporting the role of diagnostic ultrasound assessment in all areas of anesthesiology practice have propelled this growth.With these advances, the utility of perioperative ultrasound has been solidified and incorporated into educational directives. Cardiac ultrasound has been added to the list of core competencies for anesthesiologists provided by governing bodies of medical education (Accreditation Council for GraduateMedical Education), and onto the content outline for anesthesiology board certification (American Board of Anesthesiology) in the United States. Despite the growing support for focused cardiac ultrasound (FOCUS), there is still wide variation in the utilization of this technology in perioperative environments. There are myriad reasons for delayed adoption of FOCUS by anesthesiologists, including lack of training and potential unfamiliarity with when and how to incorporate FOCUS into anesthetic practice. As the phrases point of care ultrasound (POCUS), “FOCUS,” and “perioperative echocardiography” come into daily use, anesthesiologists have the opportunity to advance patient care and add value to their practice with ultrasound. This article will review the scope and limitations of FOCUS, and the current evidence for the use of FOCUS throughout the perioperative setting, including preoperative, intraoperative, and postoperative arenas and relevant work-flow considerations.