Promoting and training POC ultrasound technology. Hospitals and enterprises are constantly striving forward.

Anesthetics, needles, and anesthesia machines are used in various ways to ensure patients feel no pain during surgery. In the eyes of many, the work of anesthesiologists is quite simple. However, alleviating pain related to surgical trauma is only a small part of an anesthesiologist's job. Most of the time, anesthesiologists work on regulating basic life functions and protecting vital organs.

With the development of visualization technologies such as ultrasound imaging, especially point-of-care ultrasound (POCUS, referring to ultrasound examinations performed at the patient's bedside) in the field of anesthesia,POC，point-of-careanesthesiologists can use ultrasound-guided precise nerve blocks to improve the effectiveness and safety of regional anesthesia, reduce the proportion of general anesthesia or the use of opioid analgesics to a certain extent, reduce anesthesia risks, and promote postoperative recovery. On the other hand, anesthesiologists use ultrasound technology to make more accurate assessments of patients' vital organ functions in the perioperative period, improve the efficiency of diagnosis and treatment of critical conditions that threaten patients' lives, and more effectively monitor and regulate basic life functions and protect and support vital organs. In short,POCThe widespread application of technology in anesthesiology has improved the clinical skills of anesthesiologists, enhanced the medical service capabilities of anesthesiology, and promoted the development of anesthesiology and surgery.

PromotingPOCUltrasound technology helps improve diagnosis and treatment.

“A person's basic life functions include respiration, heart rate, pulse, blood pressure, internal environment, and neurological function. Due to surgical risks, anesthesia risks, and the health hazards of the patient's own surgical diseases and comorbidities, the main work of anesthesiologists now is to monitor and regulate the patient's basic life functions, protect and support vital organs, and ensure the patient's life safety during the perioperative period.” This was stated by Liu Jin, director of the Department of Anesthesiology at West China Hospital of Sichuan University,2019during an interview at the West China Perioperative Medicine International Academic Week and the 10th West China Application Conference of Visualization Technology in Anesthesia, Analgesia and Critical Emergency Rescue.

Liu Jin, director of the Department of Anesthesiology at West China Hospital of Sichuan University

“Before the advent of visualization technology, because the respiratory system, circulatory system, nervous system, and other human systems are located inside the human body, physicians could only observe the surface with the naked eye during monitoring and treatment, leading to blindness in the operation and diagnosis of these systems. However,POCultrasound technology can help physicians overcome the limitations of the naked eye's inability to see through, allowing them to see the human systems within the body cavity and observe changes in the system's status in a timely manner. In addition, during anesthesia, the position of the needle tip and tube tip can be monitored for accuracy, ensuring 'seeing is believing'. Therefore,POCthe application of ultrasound and other visualization technologies has significantly improved medical quality and brought great benefits to patients.” Liu Jin further pointed out the significance of the emergence of ultrasound technology,POCAnother advantage of ultrasound technology is its portability. Ultrasound equipment can be moved to the patient's side as needed by the clinician, making it particularly suitable for departments such as anesthesiology,ICUand emergency departments where patients are not easily moved.

“Today, the strategic significance of the popularization of ultrasound technology in clinical departments such as anesthesiology is similar toPOCthe popularization of stethoscopes among medical staff years ago or120the popularization of bedside electrocardiograms years ago, raising the level of clinical diagnosis and treatment to a new level.” In Liu Jin's view,60ultrasound technology, after further integration with intelligence and big data in the future, will see further improvements. “In the future, the departments that skillfully masterPOCultrasound technology will be the best-developed departments.” Liu Jin said with certainty.POC“

The application of ultrasound in anesthesiology mainly focuses on ultrasound-guided vascular puncture, nerve block, and intraoperative transesophageal echocardiography (POCTEE) etc. This is different from the ultrasound performed by the ultrasound department for patients; those departments use ultrasound for disease diagnosis.” Zuo Yunxia, deputy director of the Department of Anesthesiology at West China Hospital of Sichuan University, added. At the same time, she also explained theultrasound applications in the Department of Anesthesiology in detail, such as ultrasound-guided central venous puncture, which can accurately locate the position and depth of the blood vessels, identify ectopic blood vessel pathways, avoid accidental puncture of arteries and damage to the pleura and lung tissue, improve the success rate on the first attempt, and reduce puncture complications.POCConducting

ultrasound training; the hospital is taking action.POCAccording to Zuo Yunxia, currently, every heart surgery at West China Hospital is performed with transesophageal ultrasound by anesthesiologists. This is because transesophageal ultrasound examination avoids interference from the surgical area and lung tissue, allowing the probe to be closer to the heart. By observing the working conditions of the various chambers and valves of the heart before and after surgery, it helps to judge the surgical effect on the one hand and guide the anesthesiologist in regulating circulatory function on the other. This effectively improves the safety and success rate of heart surgery. The anesthesiology department of West China Hospital has

been holding the West China Application Conference of Visualization Technology in Anesthesia, Analgesia and Critical Emergency Rescue since overcoming various difficulties in the promotion process and has been committed to promotion work.2009Zuo Yunxia, deputy director of the Department of Anesthesiology at West China Hospital of Sichuan University

Zuo Yunxia stated,

“In addition to the laboratory and radiology departments, the ultrasound department is also involved in the auxiliary diagnosis of diseases. Ultrasound technology is most widely used in disease diagnosis, and it is indispensable in various departments such as internal medicine, surgery, obstetrics and gynecology, and pediatrics. Currently, various clinical departments mainly rely on the examination reports from the ultrasound department. If clinical specialists can masterthe technology and move the ultrasound machine to the outpatient diagnostic room and ward, it will undoubtedly improve the quality and efficiency of medical services in many clinical specialties. After all, the sensitivity and accuracy of the ultrasound probe in disease diagnosis exceed the clinician's sense of touch and stethoscope.”POCAt the same time, she also pointed out that in order to enable more clinicians, especially perioperative physicians such as anesthesiologists, emergency physicians, and critical care physicians, to master ultrasound technology, West China Hospital popularizes basic ultrasound technology and skills for clinicians through visualization conferences and ultrasound training courses, and focuses on training key ultrasound technologies to solve perioperative clinical problems. Since

this work was launched, anesthesiologists, pain physicians, emergency physicians, and2009年开展此项工作以来，全国各地的麻醉科医师、疼痛科医师、急诊科医师和ICUPhysician5000Many people participated in the visualization conference,2000Many people participated in the Huaxi Hospital's3day ultrasound technology training course,200Many people participated in the3month transesophageal ultrasound technology training course. Currently, after these trained physicians return to their respective hospitals, they not only apply it clinically, but also "branch out", holding similar training courses to cultivate more professionals who masterPOCperioperative clinical physicians with this technology.

As China's first anesthesiology physician to perform transesophageal ultrasound, Liu Jin believes that the training course lectures are still in the initial stage.“Now, we need to conduct batch, centralized, and standardized training based on the current foundation. As the first director of the Ultrasound Group of the Anesthesiology Branch of the Chinese Medical Association, during the handover with the current director, we divided the application of ultrasound in anesthesia into three parts: transesophageal ultrasound, surface ultrasound monitoring and evaluation, and ultrasound-guided nerve block and arteriovenous puncture and cannulation. A three-month standardized training outline has been developed for each part. The outline has now been issued, and Huaxi Hospital's training strictly follows the outline.”

“Physicians can learn each section separately as needed, or they can complete all three parts in nine months. Although the learning time is long, I hope that after systematic learning, students will spend another three months conducting some ultrasound-related clinical research, so that the acquired skills can be more solid.”

In addition, regarding the current controversy in China about the necessity for anesthesiology physicians to master ultrasound technology,Zuo Yunxia hopes that relevant departments can provide certain support, establish corresponding mechanisms, and issue corresponding qualification certificates to prove the qualifications of qualified trainees.

PopularizationPOCUltrasound equipment and technology The whole industry is working hard

At the Huaxi Visualization Conference training course, physician trainees from all over the country listened attentively while recording the lecture process with their Mobile phones. One trainee said,“Many problems encountered in daily work were solved through the teacher's explanation. Moreover, under the teacher's guidance and demonstration, the technique of manipulating the probe was also corrected.”

Trainees attentively listening to the teacher's lecture at the training course

According to Zuo Yunxia, the training course is a"required course" for each physician participating in the visualization conference. “Early training courses required hiring experts from the United States, which was expensive. This problem was solved after cooperation with ultrasound imaging technology companies. Logically, manufacturers have no obligation to participate in training. However, the participation of enterprises not only solved the equipment problem but also solved the training funding problem to a certain extent.”

Regarding China's existing ultrasound equipment and technology, Liu Jin pointed out,“In recent years, the development of ultrasound equipment has been very rapid. Currently in China, equipment manufacturers have their own advantages and disadvantages. When purchasing equipment, hospitals should consider the specific Model and manufacturer based on the current needs of the department. In general, domestic equipment is developing rapidly and can meet the clinical needs of most anesthesiology physicians, and the Price is also relatively reasonable. Of course, compared with some brands from developed countries, the equipment of Chinese enterprises is slightly behind in some aspects, but some enterprises, including Mindray, are working hard and making rapid progress.” While affirming the national ultrasound Brand enterprises, Liu Jin also put forward higher requirements for enterprises. Taking single-plane ultrasound esophageal probes as an example, he hopes that China's ultrasound equipment enterprises can cooperate with clinical physicians to strive for overtaking on a curve and leading the world.

Due to the rapid development of ultrasound imaging technology in recent years, more and more enterprises are committed to promoting the clinical application of ultrasound imaging equipment and technology. According to MindrayPOCUltrasound China Regional Manager Shan Juan, in China's ultrasound imaging equipment market, national ultrasound Brands represented by Mindray have not only replaced imported Brands in mid-to-low-end products but are also seizing the high-end market.

“Mindray1996year to Enter the ultrasound field. After integrating global R&D resources, the successively launchedResona 7high-end desktop color ultrasound system, portable ultrasound systemM9，the industry's first batch of touch ultrasound systemsTE 7and other instruments have been well received by ultrasound physicians.” When talking about the current status of China's ultrasound imaging technology development and his views on the overall industry, Shan Juan said, "With the development of ultrasound imaging technology, MindrayPOCultrasound currently covers a full range of Models from desktop color ultrasound to highly integrated portable color ultrasound equipment. As a national Brand, we must not only strive to meet the needs of clinical physicians in China but also have a responsibility to work with clinical physicians to promote the development of China's ultrasound imaging technology and overall medical level. Since entering the medical imaging field, we have hired professional imaging physicians to conduct product installation training, pre-sale usage training, and pre-sale demonstrations for various hospitals. In the future, we are willing to continue to cooperate with qualified medical colleges or hospitals to popularize ultrasound equipment and promotePOCultrasound technology to contribute our modest efforts.” (Dong Tong)