Transthoracic echocardiography in the perioperative setting.

PURPOSE OF REVIEW: A need for further assessment of patients in the perioperative setting and an increasing availability of ultrasonography equipment have facilitated the diffusion of ultrasonography and lately focused transthoracic echocardiography (TTE) in anesthesiology practice. This review will discuss the possible use of focused TTE in the perioperative setting and provides an update on present and future perspectives. RECENT FINDINGS: Several studies focusing on patient management and diagnostic accuracy of perioperative, focused TTE, have been published recently. Several multidisciplinary guidelines addressing use and educational aspects of focused ultrasonography are available, yet guidelines focusing solely on the use in the perioperative setting are lacking. SUMMARY: Hemodynamically significant cardiac disease or pathophysiology can be disclosed using TTE. Focused TTE is feasible for perioperative patient management and monitoring and will be an inevitable and indispensable tool for the anesthetist. Future research should focus on the outcome of perioperative TTE performed by anesthetists, using rigorous study designs and patient-centered outcomes such as mortality and morbidity.

[Pulmonary embolus after adder bite].

The clinical course after adder bites (Vipera berus) is unpredictable. Antivenom can reduce morbidity markedly. Preventive use of low-molecular-weight heparin is not routinely recommended. We present a case report, where indication for antivenom was not found, and the patient developed pulmonary embolus. Thrombotic complications are known, but to our knowledge pulmonary embolus has not previously been described in the literature.