Editorial
Perioperative Ultrasound: The challenge of applying an old technology in new clinical settings
Ultrasonido Perioperatorio: El reto de aplicar una vieja tecnología en nuevos escenarios clínicos
María Fernanda Rojas-Gómeza,
, Antonio José Bonilla-Rb
Corresponding author
mariafernanda.mfrojas@gmail.com
Corresponding author at: Anaesthetist, Sociedad Especializada de Anestesiología SEA S.A. Floridablanca, Santander, Colombia.
Corresponding author at: Anaesthetist, Sociedad Especializada de Anestesiología SEA S.A. Floridablanca, Santander, Colombia.
a Anaesthetist, Sociedad Especializada de Anestesiología SEA S.A. Clínica Carlos Ardila Lülle, Fellow in Ultrasound-guided Regional Anaesthesia WFSA – CLAS-SBA, Floridablanca, Santander, Colombia
b Assistant Professor, Pontificia Universidad Javeriana Medical School, Anaesthetist, Pain Clinic Coordinator, Hospital Universitario San Ignacio, Fellow in Regional Anaesthesia and Pain, AIPPS University of Pittsburgh Medical Center, Founding Member of the Ultrasound Applications Committee, Sociedad Cundinamarquesa de Anestesiología, Bogotá D.C., Colombia
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Clínica Carlos Ardila Lülle, Fellow in Ultrasound-guided Regional Anaesthesia WFSA – CLAS-SBA, Floridablanca, Santander, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Assistant Professor, Pontificia Universidad Javeriana Medical School, Anaesthetist, Pain Clinic Coordinator, Hospital Universitario San Ignacio, Fellow in Regional Anaesthesia and Pain, AIPPS University of Pittsburgh Medical Center, Founding Member of the Ultrasound Applications Committee, Sociedad Cundinamarquesa de Anestesiología, Bogotá D.C., Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author at</span>: Anaesthetist, Sociedad Especializada de Anestesiología SEA S.A. Floridablanca, Santander, Colombia." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ultrasonido Perioperatorio: El reto de aplicar una vieja tecnología en nuevos escenarios clínicos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In anaesthesia, anticipating problems and responding quickly and effectively to peri-operative risks to the patient is crucial. As a result of recent technological advances over the last few decades, ultrasound has emerged as a tool to guide a huge number of procedures in the practice of various specialties. In particular in anaesthesia, it has become critical in establishing vascular accesses, providing regional anaesthesia,<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1–9</span></a> performing interventional procedures for acute and chronic pain relief,<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> and for gathering relevant qualitative information for the diagnosis or treatment of low output syndromes,<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11–15</span></a> hypovolemia, acute pulmonary events,<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> and for the assessment of gastric content as a risk for aspiration,<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> and assessment of the airway, among other things.<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">18–20</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The world literature supports the current use of ultrasound as an extension of the physical examination and as a teaching tool in undergraduate<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> and graduate education.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> It is one more among the technologies that are part of the “Point of Care” concept, brought to the patient's bed to help with decision-making.<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">23–26</span></a> The application of any new technology or diagnostic tool as part of medical practice must be framed within ethics and good clinical practices, something to which we cannot be indifferent.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Along the same lines, the application of an old technology in a new clinical setting by practitioners other than those traditionally linked to it, may be associated with vulnerabilities. This is precisely the fair source of concern of our Radiology colleagues, a situation which we fully understand from the point of view of education and development of skills.<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">27,28</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The widespread use of ultrasound during the peri-operative period constitutes a challenge for future anaesthesia training in formal and non-formal settings.<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">29–35</span></a> Consequently, the introduction of ultrasound into anaesthesia training programmes, focusing on specific objectives by areas, becomes relevant. Like in non-formal education or in continuing medical education, the analysis of Miller's pyramid is warranted: knowing, knowing how, showing how, and finally mastering the skill. However, arriving at the top of the pyramid is not easy.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Consequently, which should be the scope of continuing medical education courses and training outside the academic setting?<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">32,36–40</span></a> Do they confer the knowledge, and the know-how? Do they result in the achievement of competencies? Are just one, two, or three workshops enough? What kind of exposure is needed? What is the time required to develop the skill for using ultrasound correctly in a given clinical context? Does competency in one skill make the practitioner competent in the others? These and other questions emerge and must be answered responsibly.</p><p id="par0030" class="elsevierStylePara elsevierViewall">It is up to scientific societies to answer these questions and create or provide guidelines for determining the right settings for skill development, working along a sound and structured path of continuing education. This is a great challenge to which we must and should rise as professionals and educators, driven by the benefits and the academic and scientific advancement in the world, in order to make sure that new generations of colleagues and those already in medical practice may profit from this resource that has revolutionised clinical practice in the majority of medical settings, for the benefit of our patients for whom we ultimately exist.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors did not receive sponsorship to carry out this article.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rojas-Gómez MF, Bonilla-R AJ. Ultrasonido Perioperatorio: El reto de aplicar una vieja tecnología en nuevos escenarios clínicos. Rev Colomb Anestesiol. 2016;44:267–269.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:40 [ 0 => array:3 [ "identificador" => "bib0205" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia and pain medicine: executive summary" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Neal" 1 => "R. Brull" 2 => "V.W.S. Chan" 3 => "S. Grant" 4 => "J.-L. Horn" 5 => "S.S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 0 | 3 |
| 2024 October | 12 | 6 | 18 |
| 2024 September | 18 | 2 | 20 |
| 2024 August | 19 | 2 | 21 |
| 2024 July | 24 | 3 | 27 |
| 2024 June | 20 | 5 | 25 |
| 2024 May | 21 | 4 | 25 |
| 2024 April | 16 | 2 | 18 |
| 2024 March | 34 | 11 | 45 |
| 2024 February | 13 | 9 | 22 |
| 2024 January | 14 | 4 | 18 |
| 2023 December | 14 | 6 | 20 |
| 2023 November | 14 | 8 | 22 |
| 2023 October | 15 | 9 | 24 |
| 2023 September | 9 | 6 | 15 |
| 2023 August | 12 | 4 | 16 |
| 2023 July | 8 | 5 | 13 |
| 2023 June | 12 | 3 | 15 |
| 2023 May | 39 | 6 | 45 |
| 2023 April | 46 | 7 | 53 |
| 2023 March | 9 | 1 | 10 |
| 2023 February | 10 | 3 | 13 |
| 2023 January | 8 | 1 | 9 |
| 2022 December | 15 | 9 | 24 |
| 2022 November | 16 | 7 | 23 |
| 2022 October | 18 | 10 | 28 |
| 2022 September | 16 | 10 | 26 |
| 2022 August | 22 | 7 | 29 |
| 2022 July | 8 | 8 | 16 |
| 2022 June | 8 | 8 | 16 |
| 2022 May | 9 | 9 | 18 |
| 2022 April | 9 | 6 | 15 |
| 2022 March | 9 | 7 | 16 |
| 2022 February | 5 | 6 | 11 |
| 2022 January | 9 | 6 | 15 |
| 2021 December | 5 | 6 | 11 |
| 2021 November | 8 | 8 | 16 |
| 2021 October | 8 | 9 | 17 |
| 2021 September | 11 | 5 | 16 |
| 2021 August | 12 | 7 | 19 |
| 2021 July | 13 | 7 | 20 |
| 2021 June | 6 | 10 | 16 |
| 2021 May | 13 | 4 | 17 |
| 2021 April | 30 | 9 | 39 |
| 2021 March | 11 | 4 | 15 |
| 2021 February | 8 | 7 | 15 |
| 2021 January | 6 | 7 | 13 |
| 2020 December | 9 | 6 | 15 |
| 2020 November | 5 | 3 | 8 |
| 2020 October | 6 | 5 | 11 |
| 2020 September | 10 | 7 | 17 |
| 2020 August | 4 | 6 | 10 |
| 2020 July | 8 | 8 | 16 |
| 2020 June | 9 | 2 | 11 |
| 2020 May | 7 | 3 | 10 |
| 2020 April | 2 | 5 | 7 |
| 2020 March | 7 | 3 | 10 |
| 2020 February | 8 | 5 | 13 |
| 2020 January | 4 | 3 | 7 |
| 2019 December | 7 | 6 | 13 |
| 2019 November | 5 | 0 | 5 |
| 2019 October | 5 | 2 | 7 |
| 2019 September | 1 | 2 | 3 |
| 2019 August | 0 | 1 | 1 |
| 2019 July | 0 | 5 | 5 |
| 2019 June | 1 | 1 | 2 |
| 2019 May | 3 | 10 | 13 |
| 2018 September | 1 | 0 | 1 |
| 2018 June | 4 | 5 | 9 |
| 2018 May | 25 | 9 | 34 |
| 2018 April | 36 | 10 | 46 |
| 2018 March | 26 | 8 | 34 |
| 2018 February | 26 | 10 | 36 |
| 2018 January | 31 | 9 | 40 |
| 2017 December | 13 | 8 | 21 |
| 2017 November | 20 | 7 | 27 |
| 2017 October | 25 | 10 | 35 |
| 2017 September | 21 | 14 | 35 |
| 2017 August | 19 | 11 | 30 |
| 2017 July | 23 | 7 | 30 |
| 2017 June | 34 | 11 | 45 |
| 2017 May | 29 | 14 | 43 |
| 2017 April | 33 | 19 | 52 |
| 2017 March | 20 | 8 | 28 |
| 2017 February | 21 | 5 | 26 |
| 2017 January | 24 | 10 | 34 |
| 2016 December | 70 | 22 | 92 |
| 2016 November | 78 | 23 | 101 |
| 2016 October | 81 | 21 | 102 |
| 2016 September | 4 | 4 | 8 |
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