Colombian Journal of Anesthesiology Colombian Journal of Anesthesiology
Rev Colomb Anestesiol 2016;44:267-9 - Vol. 44 Num.4 DOI: 10.1016/j.rcae.2016.08.005
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
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

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,1–9 performing interventional procedures for acute and chronic pain relief,10 and for gathering relevant qualitative information for the diagnosis or treatment of low output syndromes,11–15 hypovolemia, acute pulmonary events,16 and for the assessment of gastric content as a risk for aspiration,17 and assessment of the airway, among other things.18–20

The world literature supports the current use of ultrasound as an extension of the physical examination and as a teaching tool in undergraduate21 and graduate education.22 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.23–26 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.

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.27,28

The widespread use of ultrasound during the peri-operative period constitutes a challenge for future anaesthesia training in formal and non-formal settings.29–35 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.

Consequently, which should be the scope of continuing medical education courses and training outside the academic setting?32,36–40 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.

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.


The authors did not receive sponsorship to carry out this article.

Conflicts of interest

The authors have no conflicts of interest to declare.

J.M. Neal,R. Brull,V.W.S. Chan,S. Grant,J.-L. Horn,S.S. Liu
The ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia and pain medicine: executive summary
Reg Anesth Pain Med, 35 (2010), pp. S1-S9
V. Mathur,E.D. Bravos,C. Vallera,C.L. Wu
Regional anesthesia and patient outcomes: evidence-based medicine
Tech Reg Anesth Pain Manag, 12 (2008), pp. 163-170
B.D. Sites,R. Brull
Ultrasound guidance in peripheral regional anesthesia: philosophy, evidence-based medicine, and techniques
Curr Opin Anaesthesiol, 19 (2006), pp. 630-639
J.G. Antonakakis,P.H. Ting,B. Sites
Ultrasound-guided regional anesthesia for peripheral nerve blocks: an evidence-based outcome review
Anesthesiol Clin, 29 (2011), pp. 179-191
J.M. Neal
Ultrasound-guided regional anesthesia and patient safety: update of an evidence-based analysis
Reg Anesth Pain Med, 41 (2010), pp. 195-204
Guidelines for fellowship training in Regional Anesthesiology and Acute Pain Medicine: second edition, 2010
Reg Anesth Pain Med, 36 (2011), pp. 282-288
B. Fischer
Benefits, risks, and best practice in regional anesthesia: do we have the evidence we need?
Reg Anesth Pain Med, 35 (2010), pp. 545-548
S.N. Narouze,D. Provenzano,P. Peng,U. Eichenberger,S.C. Lee,B. Nicholls
The American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies Joint Committee recommendations for education and training in ultrasound
Reg Anesth Pain Med, 37 (2012), pp. 657-664
S. Dhir,S. Ganapathy,A. Dhir
Role of ultrasound guidance in regional anesthesia
Kuwait Med J, 39 (2007), pp. 4-9
A. Bhatia,R. Brull
Is ultrasound guidance advantageous for interventional pain management? A systematic review of chronic pain outcomes
Anesth Analg, 117 (2013), pp. 236-251
V. Sharma,S.N. Fletcher
A review of echocardiography in anaesthetic and peri-operative practice. Part 2: Training and accreditation
Anaesthesia, 69 (2014), pp. 919-927
K.T. Spencer,B.J. Kimura,C.E. Korcarz,P.A. Pellikka,P.S. Rahko,R.J. Siegel
Focused cardiac ultrasound: recommendations from the American Society of Echocardiography
J Am Soc Echocardiogr, 26 (2013), pp. 567-581
F. Conlin,N. Roy Connelly,K. Raghunathan,J. Friderici,A. Schwabauer
Focused transthoracic cardiac ultrasound: a survey of training practices
J Cardiothorac Vasc Anesth, 30 (2016), pp. 102-106
S.K. Shillcutt,J.S. Bick
A comparison of basic transthoracic and transesophageal echocardiography views in the perioperative setting
Anesth Analg, 116 (2013), pp. 1231-1236
O. Shakil,F. Mahmood,R. Matyal
Simulation in echocardiography: an ever-expanding frontier
J Cardiothorac Vasc Anesth, 26 (2012), pp. 476-485
M. Colmenero,M. García-Delgado,I. Navarrete,G. López-Milena
Utilidad de la ecografía pulmonar en la unidad de medicina intensiva
Med Intensiva, 34 (2010), pp. 620-628
C. Arzola,A. Perlas,N.T. Siddiqui,J.C.A. Carvalho
Bedside gastric ultrasonography in term pregnant women before elective cesarean delivery: a prospective cohort study
Anesth Analg, 121 (2015), pp. 752-758
P. Kundra,S.K. Mishra,A. Ramesh
Ultrasound of the airway
Indian J Anaesth, 55 (2011), pp. 456-462
J. Dinsmore,A.M.B. Heard,R.J. Green
The use of ultrasound to guide time-critical cannula tracheotomy when anterior neck airway anatomy is unidentifiable
Eur J Anaesthesiol, 28 (2011), pp. 506-510
A.C. Adler,W.J. Greeley,F. Conlin,J.M. Feldman
Perioperative anesthesiology ultrasonographic evaluation (PAUSE): a guided approach to perioperative bedside ultrasound
J Cardiothorac Vasc Anesth, 30 (2016), pp. 521-529
O.H. Baltarowich,D.N. Di Salvo,L.M. Scoutt,D.L. Brown,C.W. Cox,M.A. DiPietro
National ultrasound curriculum for medical students
S. Bennett
Training guidelines for ultrasound: worldwide trends
Best Pract Res Clin Anaesthesiol, 23 (2009), pp. 363-373
B.P. Cholley
International expert statement on training standards for critical care ultrasonography
Intensive Care Med, 37 (2011), pp. 1077-1083
R. Deshpande,S. Akhtar,A. Haddadin
Utility of ultrasound in the ICU
Curr Opin Anaesthesiol, 27 (2014), pp. 123-132
G. Volpicelli
Point-of-care lung ultrasound
Praxis (Bern 1994), 103 (2014), pp. 711-716
D. Ramsingh,J. Rinehart,Z. Kain,S. Strom,C. Canales,B. Alexander
Impact assessment of perioperative point-of-care ultrasound training on anesthesiology residents
Anesthesiology, 123 (2015), pp. 670-682
R.J. Slater,D.J. Castanelli,M.J. Barrington
Learning and teaching motor skills in regional anesthesia: a different perspective
Reg Anesth Pain Med, 39 (2014), pp. 230-239
M.J. Barrington,D.M. Wong,B. Slater,J.J. Ivanusic,M. Ovens
Ultrasound-guided regional anesthesia
Reg Anesth Pain Med, 37 (2012), pp. 334-339
S.E. Skochelak
A decade of reports calling for change in medical education: what do they say?
S.L. Kopp,H.M. Smith
Developing effective web-based regional anesthesia education
Reg Anesth Pain Med, 36 (2011), pp. 336-342
Y. Vovides,S.B. Chale,R. Gadhula,M.B. Kebaetse,N.A. Nigussie,F. Suleman
A systems approach to implementation of eLearning in medical education: five MEPI Schools’ journeys
J.J.H. Cheung,E.W. Chen,Y. Al-Allaq,N. Nikravan,C.J.L. McCartney,A. Dubrowski
Acquisition of technical skills in ultrasound-guided regional anesthesia using a high-fidelity simulator
Stud Health Technol Inform, 163 (2011), pp. 119-124
J. Luz,I. Siddiqui,N.B. Jain,M.J. Kohler,J. Donovan,P. Gerrard
Resident-perceived benefit of a diagnostic and interventional musculoskeletal ultrasound curriculum: a multifaceted approach using independent study, peer teaching, and interdisciplinary collaboration
Am J Phys Med Rehabil/Assoc Acad Physiatr, 94 (2015), pp. 1095-1103
L. Neri,E. Storti,D. Lichtenstein
Toward an ultrasound curriculum for critical care medicine
Crit Care Med, 35 (2007), pp. S290-S304
B.E. Hashimoto,C. Kasales,D. Wall,J. McDowell,M. Lee,U.M. Hamper
Teaching ultrasound professionalism
J.T. Wegener,C.T. van Doorn,J.H. Eshuis,M.W. Hollmann,B. Preckel,M.F. Stevens
Value of an electronic tutorial for image interpretation in ultrasound-guided regional anesthesia
Reg Anesth Pain Med, 38 (2013), pp. 44-49
B.D. Sites,B.C. Spence,J.D. Gallagher,C.W. Wiley,M.L. Bertrand,G.T. Blike
Characterizing novice behavior associated with learning ultrasound-guided peripheral regional anesthesia
Reg Anesth Pain Med, 32 (2007), pp. 107-115
T. Grau,E. Bartusseck,R. Conradi,E. Martin,J. Motsch
Ultrasound imaging improves learning curves in obstetric epidural anesthesia: a preliminary study
Can J Anaesth, 50 (2003), pp. 1047-1050
B.D. Sites,J.D. Gallagher,J. Cravero,J. Lundberg,G. Blike
The learning curve associated with a simulated ultrasound-guided interventional task by inexperienced anesthesia residents
Reg Anesth Pain Med, 29 (2004), pp. 544-548
Y. Liu,N.L. Glass,R.W. Power
New teaching model for practicing ultrasound-guided regional anesthesia techniques: no perishable food products!
Anesth Analg, 110 (2010), pp. 1233-1235

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.

Corresponding author at: Anaesthetist, Sociedad Especializada de Anestesiología SEA S.A. Floridablanca, Santander, Colombia.
Copyright © 2016. Sociedad Colombiana de Anestesiología y Reanimación

Based on the paper that you have consulted please tell us the grade of agreement or disagreement to the following statements, where 1 is totally disagree and 5 totally disagree:

The content that I consulted shows a high scientific quality.

  • 1 - Strongly disagree
  • 2 - Disagree
  • 3 - Neither agree nor disagree
  • 4 - Agree
  • 5 - Strongly agree

The content that I consulted is useful to my professional and academic labors.

  • 1 - Strongly disagree
  • 2 - Disagree
  • 3 - Neither agree nor disagree
  • 4 - Agree
  • 5 - Strongly agree
Rev Colomb Anestesiol 2016;44:267-9 - Vol. 44 Num.4 DOI: 10.1016/j.rcae.2016.08.005