Year : 2007 | Volume
| Issue : 2 | Page : 51-52
Ultrasound in anesthesia
Mohamed Bilal Delvi
Department of Anaesthesia, College of Medicine, King Saud University, Saudi Arabia
Mohamed Bilal Delvi
Department of Anaesthesia, College of Medicine, King Saud University
Source of Support: None, Conflict of Interest: None
|Date of Web Publication||18-Jul-2009|
|How to cite this article:|
Delvi MB. Ultrasound in anesthesia. Saudi J Anaesth 2007;1:51-2
ULTRASOUND IS GAINING POPULARITY in routine anesthesia practice, both in the operating room as well as in intensive care units. In the past ultrasound equipment was bulky and image management needed expertise in the field of radiology. Over the years equipment has shrunk in size and images are crisp and clear, physicians with minimum experience in ultrasound have a very steep learning curve, needs a hand- eye coordination and plane orientation. Ultrasound is evolving to be an asset in the armamentarium of modern anesthesiologists. The main argument from the critics of ultrasound is the cost of the equipment, it is acknowledged as a considerable investment but a long term investment, reimbursement of this cost depends on the extent of use and training of staff in utilizing the resources in an optimal manner. Sandhu et al in a study on the cost comparison concluded that ultrasound guidance was more economical than nerve stimulation technique with a high case load  .
In 1994, Winnie stated, "Sooner or later someone will make a sufficient close examination of the anatomy involved, so that exact techniques will be developed  . Anatomy is the basis of either learning or teaching regional anesthesia, in ultrasound "Sonoanatomy" is to be mastered by extensive practice and attending courses either conducted by our radiology colleagues or ultrasound guided nerve block workshops, it is very important to continue the knowledge gained in a workshop or course and put it to practical use in daily routine work to master any technique. The first reported blocks utilizing ultrasound was way back in 1978, the interest reemerged in the mid 1990s; this may have been due to fast evolving equipment and computer technology. Most of the studies in the literature describe many ways to approach the brachial plexus, lower limb blocks are gaining popularity after two studies by Marhofer and colleagues described them in 1997 and 1998, in the first study ultrasound was compared with nerve stimulation to assess the quality and onset time, but this was not blinded and the method was not well explained. In the second study they compared three groups of patient to different doses of local anaesthetic, ultrasound group received 20 ml of 0.5% bupivacaine, and two nerve stimulation groups received 20 ml and 30 ml respectively. The overall success rate was 95% in the ultrasound group and 80% in each of the other groups  .
Ultrasound guided regional blocks are becoming popular in the Middle East, this is due to easy accessibility to high resolution equipment as many centers are ordering top of line ultrasound machines for various departments including anesthesia, a few research projects are in their infancy and we hope that more and more research and evidence based studies roll out as there is lot of interest shown by the faculty in the universities and teaching centers to the new technology. We have conducted a few workshops during the three years of ultrasound experience in our center, we saw a lot of interest and enthusiasm among the registrants and many of them were requesting to join a center teaching this technique for a period of time to master it. There is a lot of potential to utilize the resources and facilities provided in this part of the world for the benefit of both trainees and patients. A humble suggestion to the pioneers of anesthesia in the Arab region, we need to have a society dedicated to regional anesthesia in par with ASRA, ESRA, or the Asian chapter, this will encourage more research and conferences in this field. At present a part of the time other than prime time is allotted to regional anesthesia in major conferences and the publications are negligible in the major anaesthesia journals of this area.
This issue of SJA carries a very interesting and important research on ultrasound imaging of ulnar nerve in the forearm, I was also a volunteer subject in the project, it is very interesting to note the conclusion drawn and by that I realized the reason for regular pattern of patchy block after the ulnar nerve block by traditional surface landmarks and injecting just above the head of the ulna at the wrist. Ultrasound in the intensive care has proved to be a very useful equipment in inserting difficult central venous lines (CV) as in obese or difficult landmarks identification, it is also useful in inserting arterial lines, needles for percutaneous tracheostomy before guide wire insertion, other than the routine use of ultrasound in the ICU .There was a recent editorial recommending the routine use of ultrasound in every CV catheter insertion, in UK it is a mandatory technique if ultrasound is available. 
In summary it is always being asked "Why Ultrasound" and many lectures are aimed at explaining the benefits of ultrasound, in one of our workshops a colleague while concluding the talk asked the audience let us change this "Why" to "Why not Ultrasound".
Seeing is believing!
| References|| |
|1.||Sandhu NS, Sidhu DS, Capan LM. The cost comparison of infraclavicular brachial plexus block by nerve stimulator and ultrasound guidance. Anesth Analg. 2004; 98:267-268. |
|2.||Winnie AP, Hoakansson L. Plexus Anaesthesia: Perivascular Techniques of Brachial Plexus Blocks. Revised Edition. Philadelphia: Saunders 1994. |
|3.||Editorial - British Journal of Anaesthesia 2007; 98 (3):299301. |
|4.||Marhofer P,Schrogendorfer K, Wallner T, Koinig H, Mayer N, Kapral S. Ultrasonographic guidance reduces the amount of local anaesthetic for 3-1 Blocks. Reg Anaesthesia and Pain Med 1998; 23:584-8. |
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