Know any good books to learn transthoracic echo or regional anes and ultrasound?

[jd1572]

I'm interested in learning more about the use of ultrasound in anesthesia practice, and I was wondering if anyone has any suggestions about good books to read. I've been using an ultrasound machine for peripheral nerve blocks, and then I started wondering if I could use the same machine to do transthoracic echocardiography (TTE). I figure this could be a quick way to tell if a patient is hypovolemic or needs an inotrope. If anyone knows of any TTE books that are quick and easy to read, that would be helpful. I found some books online, and I was wondering if anyone has read any of them:

Perioperative Diagnostic and Interventional Ultrasound, by Dominic Harmon et al. 2008

Atlas of Ultrasound and Nerve Stimulation-Guided Regional Anesthesia, by Ban C. H. Tsui et al.

Thanks!

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[bubalus]

Great ideas, and in my mind on the cutting edge of anesthesiology. Unfortunately, the transducers typically used for TTE and U/S regional are different. Linear probes are typically used for U/S regional (at least that's what I use), but TTE is more likely to use a phased array. In addition, the frequency of the probe will be different. You'll want 8-12 MHz for the U/S regional and 1.5-4 for the TTE.

The machine however, can be the same. You could get a Vivid-i and use it for TEE, TTE, and U/S regional. You just plug in different probes.

In my mind, it's rare to find an anesthesiologist who knows much about reading TTE, and extremely rare to find one who knows how to perform any sort of an exam. I find it very powerful. I can throw a probe on a patient in in a couple minutes have a good assessment of systolic and diastolic function, filling pressures, valves, etc. However, if it's to the point of really requiring vasopressors, they're going to get intra-op TEE.

If you want to learn about doing the exam, you should probably find one of the sonographers in your hospital and ask them if they can recommend a book. If you want to learn the interpretation part, start with The Echo Manual by Oh or one of Catherine Otto's books. For TEE, I like Perrino over Sidebotham, though both have their good points.

 

[sevo85288]

I know several anesthesiologists are who are certified in TEE and TTE. Use CARDS text for TTE training. Yes, you'll need a different probe. Can also use your sonosite with a TTE probe.

 

[New2Midwest]

The Ban Tsui regional textbook is excellent-very good images and an easy read-

 

[jd1572]

My sonosite machine has a low frequency probe that can be used for abdominal exams, so I assume that should be good enough for TTE.

Does anyone know of any good courses to learn TTE? Or how do I find out about certification for TTE? I'm not interested at this point in doing a cardiac anesthesia fellowship, so I personally won't have access to a TEE probe intra-op. I'm interested in learning about TTE for those instances when I'm on call by myself and don't have easy access to someone who can do a TEE. I do have access to an ultrasound machine for regional blocks, and I know how to use that machine, so that is why I'm interested in TTE rather than TEE.

Thanks again!

 

[bubalus]

The abdominal probe could be used, but you're not going to get images like you do with a TTE probe.

With regards to certification, the only way to get certified by the NBE in TTE is to do a 2 year fellowship and take the ASCexam and meet the requirements for number of studies. It is possible to request an exemption to 12 months of the 24 month requirement, but I think it's pretty unlikely to get it. With regards to TEE certification by the NBE, anyone graduating after 6/30/09 will have to do a fellowship as the practice pathway will not be open to them.

Sevo, can you PM me a few names. I'd like to know who they are. I still think it's extremely rare for an anesthesiologist to be certified in TTE because most will not have done 24 months of fellowship training and had the opportunity to get level 3 echo training, which is required for certification. In addition, most cardiologists haven't taken the ASCexam, much less achieved certification (and a substantial number of cards fellows only get level 2 certification). Oxorn in Seattle is one of the few exceptions I'm aware of. For example, excluding the 2008 ASCexam, only 42 people in the state of Washington are testamurs or certified. In CA, there are 163. In NY 355. In TX, 137. You can do TTE without certification, and you can do it well without certification, but being a testamur or being certified gives you a certain cachet.