Standardisierte Kontrastmittelsonographie (CEUS) in der klinischen Akut- und Notfallmedizin sowie Intensivmedizin (CEUS-Akut)

Die Anaesthesiologie -     

DGAI-certified seminar series: anaesthesia focussed echocardiography: module 4 cardiosonography

The use of ultrasonography in perioperative medicine has developed rapidly within the last decade. Today ultrasonic techniques are established methods for peripheral and central venous access as well as for regional anaesthesia. However, transthoracic ultrasonography by non-cardiologists has not yet been routinely established perioperatively, in intensive care medicine or in emergency medicine. With the current module 4: Cardiosonography of the DGAI-certified seminar series in Anaesthesia Focussed Sonography (AFS) it is intended to provide a basis for a quality assured training and implementation of transthoracic sonography in anaesthesia, intensive care medicine and emergency medicine.     

Transesophageal echocardiography in critically ill patients--techniques, indications and possibilities

TEE is one of the most versatile modalities for diagnosing and guiding treatment of critically ill patients due to its ease of use at patient bedside, the high quality imaging, the rapid availability of diagnostic information and its low complication rate (2.6%). Numerous studies habe shown a significant diagnostic (67%) and therapeutic (36%) impact on patient management in critically ill patients, particularly in cardiological and cardiosurgical populations.     

Time-varying elastance concept applied to the relation of carotid arterial flow velocity and ventricular area

OBJECTIVE: In this study, the relationship V(f)AR, which was obtained from carotid blood-flow velocity (V(f)) and the cross-sectional area (A) of the left ventricle, was used to assess changes in left ventricular (LV) systolic performance as indicated by the LV pressure-volume relationship (PVR) and end-systolic LV elastance (E(es)). BACKGROUND: The relationship of maximum systolic V(f) as a surrogate for LV pressure and end-systolic LV area as a surrogate for end-systolic LV volume may allow for the estimation of LV elastance and ejection properties. METHODS: In 25 pigs, internal carotid V(f) was recorded by using continuous-wave Doppler mode. Echocardiographic measurements of A were continuously performed with an automated border detection system and combined with data for V(f) to display V(f)AR as a series of loop diagrams. These were shifted during acute preload reduction, and an index E'(es) was calculated by applying the time varying elastance concept to end-systolic V(f)AR. Simultaneously, E(es) was acquired by conductance catheter and micromanometer techniques. Comparisons of E'(es) and E(es) were made at various contractility levels obtained by the administration of dobutamine, 5 microg/kg/min, and esmolol, 40 to 60 mg, and at various cardiac load levels, obtained by a fluid bolus infusion or administration of a vasoconstrictor. RESULTS: Highly linear elastance curves (r >or= 0.85, p < 0.0001) were derived from both end-systolic V(f)AR and PVR. Correlation of E'(es) and E(es) revealed an almost linear function: E'(es) = 0.052 + 0.11 E(es) (r = 0.98, p < 0.0001). Administration of dobutamine increased E(es) from 5.8 +/- 3.04 mmHg/mL to 10.1 +/- 4.19 mmHg/mL (p < 0.05), and E('es) from 0.68 +/- 0.288 cm(2)/min/mL to 1.24 +/- 0.458 cm(2)/min/mL (p < 0.05). After administration of esmolol, E(es) and E'(es) both dropped significantly by 3.7 +/- 2.4 mmHg/mL and 0.44 +/- 0.15 cm(2)/min/mL, respectively. No load dependency of E'(es) was seen. Bland-Altman analysis revealed that the change in E'(es), which is required to predict a significant change in E(es), should exceed +16.9% or -13.1% of the preceding value. CONCLUSION: Application of the time-varying elastance concept on the relation of V(f) and LV area allows for the determination of an index E'(es) that may be used to estimate E(es).     

DGAI-certified course series anaesthesia focused sonography: module 1: basics of sonography

Understanding the principles of wave physics paves the way for appropriate utilization and interpretation of sonography. In module 1 of the course series "Anesthesia Focused Sonography", the course participants will learn by lectures and practical training, how ultrasonic waves emerge, how they travel in human tissue, and how a picture is generated from their echo signals. Furthermore, the technology of an ultrasound system and the development of artifacts will be demonstrated; moreover, the Doppler effect and its implementation into current sonographic procedures will be presented as a central theme.     

The DGAI training module 2 in anaesthetic focussed sonography: vascular sonography

Modul 2 will provide the theory and practical training of the sonographically guided puncture of central and peripheral veins and arteries. In doing so patients of all age groups are taken into consideration. Combined with the content of the other modules this series of workshops, which was initiated by our society, might be a first step in defining a new core competency of our specialty. The confident use of ultrasound in vascular puncture sharpens our dedicated professional competence and will contribute to continuously improve the quality and safety of anaesthesiologic patient care.     

Radiation exposure in whole-body computed tomography of multiple trauma patients: bearing devices and patient positioning

BackgroundWhole-body computed tomography (WBCT) plays an important role in the management of severely injured patients. We evaluated the radiation exposure of WBCT scans using different positioning boards and arm positions.MethodsIn this retrospective study, the radiation exposure of WBCT using a 16-slice multislice computed tomography scanner was evaluated. Individual effective doses (E, mSV) was calculated. Patients were assigned to two groups according to placement on a plastic transfer mat (PTM, group 1) or on the Trauma Transfer?-Board (TTB, group 2). Data were collected for each group with arm placement on the abdomen (a) or in raising position (b), respectively. The maximum ventro-dorsal diameter [VDD] at the trunk was measured.Results100 patients with potentially life-threatening injuries were analysed. Patient demographics and VDD did not differ in the two groups. Radiation exposure in term of E did not reveal any significant differences between the two positioning boards using same arm position [group 1a (n = 26) vs. 2a (n = 24) (mSV): 16.7 ± 4.7 vs. 17.1 ± 4.4, group 1b (n = 26) vs. 2b (n = 24) (mSV): 13.1 ± 3.9 vs. 14.3 ± 1.5]. The arm raising positioning showed a significant reduction in E in comparison to the placement on abdomen position [group 1b vs. 1a (mSV): 13.1 ± 3.9 vs. 16.7 ± 4.7, p < 0.05, group 2b vs. 2a (mSV): 14.3 ± 1.5 vs. 17.1 ± 4.4, p < 0.05].ConclusionsPatient arm positioning for WBCT has an important influence on radiation exposure. Effective dose was 16–22% lower when arms were raised. An individual placement algorithm may lead to a relevant reduction of radiation exposure of severely injured patients.     

Ultrasound in anesthesiology--TEE for diagnosis and cardiovascular monitoring

Various sonographic techniques that are implemented in transesophageal echocardiography (TEE) for cardiovascular monitoring, allow for an extensive cardiac structure and function analysis. Major priority is assigned to the judgement on myocardial contractility, ventricular filling end ejection, valvular morphology and structure, as well as diagnosis of the ascending and descending aorta. Correct interpretation of the imaged structures increases diagnostic safety, but is built on high requirements on the investigator. On these grounds, this article aims to inform you on the clinical applications of TEE.