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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

Point-of-Care Ultrasound Diagnoses in Peripartum Care by Anesthesiologists

Abstract Number: T1C-7
Abstract Type: Case Report/Case Series

Ana Lisa Ramirez-Chapman MD1 ; Sonal Zambare MD2; Alice L. O'Brien MD3; Jose M. Rivers MD4; Uma Munnur MD5; Ashutosh Wali MD6

Anesthesiologists have been instrumental in the development of perioperative ultrasound for many years.Recently, there has been a dramatic increase in the utilization of ultrasound for real-time guidance of clinical decision-making and procedures.In the following two case reports,point-of-care(POC) ultrasound was used to diagnose/rule out a potentially fatal disease process:

Case 1:39 y/o G6P2 woman with a history of severe OSA,pulmonary HTN,chronic HTN,anxiety,asthma,and obesity presented with shortness of breath (SOB).Initial EKG showed T wave inversions,but the CXR and cardiac enzymes were negative.POC U/S showed good contractility of the LV and no acute RV dilation concerning for pulmonary embolism.She was placed on a Heparin infusion due to high suspicion for PE,but Doppler was negative for DVT.She was delivered via repeat C/S at 32 weeks due to her worsening pulmonary status secondary to uncontrolled OSA.Heparin was held for 12 hours prior,however she suffered PPH.Epidural anesthesia was converted to GA during surgery without complications.Post partum V/Q scan showed low probability for acute PE,yet it was decided to keep her anticoagulated for at least three months post-partum.

Case 2:43 y/o G3P0 woman with twin pregnancy and history of myomectomy presented @ 36w4d with increased leg swelling and SOB.She had pre-E with severe features and suspected pulmonary edema.Lower extremity Doppler was negative for DVT.Prior to the Cardiology/Radiology evaluation,the Anesthesiology team diagnosed pulmonary edema and a small, asymptomatic pericardial effusion using POC U/S. Early findings from POC U/S confirmed the clinical suspicion of pulmonary edema and allowed for diuresis therapy to be started immediately.Her symptoms of shortness of breath improved,and she was taken to the OR for an uneventful primary C/S secondary to her diagnosis of Pre-E with severe features.

Going forward,we must determine what kind of training qualifies an anesthesiologist to use POC U/S for making clinical decisions,integrate POC U/S training into the curriculum of anesthesia residency programs,and incorporate perioperative/peripartum POC U/S into our future practice.

Reference: 1.Lee A, Loughrey JPR. The role of ultrasonography in obstetric anesthesia. Best Practice & Research: Clinical Anaesthesiology, 2017-03-01,Volume 31,Issue 1, Pages 81-90,Copyright 2016; 2.Moore C.Point-of-Care Ultrasonography.N Engl J Med 2-24-2011, 364;8.

SOAP 2018