Echocardiography or cardiac ultrasound has long been established as an important cardiac imaging technique for acquiring real-time information about cardiac anatomy and function. The technological aspect of this cardiac ultrasound platform continues to evolve and also to migrate across patient populations, different specialities and clinical usage. Cardiac assessment and monitoring have always been an essential part of the management of the patient undergoing anaesthesia and intensive care. This chapter provides an overview of the more recent clinical aspects, training issues, technological advances and future developments in relation to these areas.

Clinical uses of echocardiography

Cardiac anaesthesia and cardiac critical care

The current interest in echocardiography by anaesthetists can be traced back to a group of cardiac anaesthetists in North America who adopted intra-operative transoesophageal echocardiography (TOE). To a varying extent they have displaced cardiologists from the cardiac theatre and developed practice guidelines and education programmes. This approach has been widely emulated in cardiac anaesthetic practice in the UK and in parts of Europe. Although no data are currently available for contemporary UK practice, 72% of anaesthetists who responded to a survey in the United States personally employed intra-operative TOE during cardiac surgery. This figure was 35% in a Canadian survey. In my own institution, intra-operative TOE is provided almost exclusively by anaesthetists, with over 400 intra-operative studies performed during 2005.