Innovation and ingenuity are known to outpace legislation and regulation. Nothing highlights this principle more than the introduction of ultrasound (US) in the practice of clinical anesthesiology. This started in the early 1990s with the use of transesophageal echocardiography (TEE) in cardiac O.R.s. It later expanded to use of transthoracic echo (TTE) in critical care settings to US guidance for invasive procedures (vascular access, regional anesthesia). This widespread use of ultrasound has come to be known as perioperative ultrasonography, which is the use of US for patient management during the perioperative period. Current applications of perioperative US that are specific to anesthesiologists include: TTE, TEE, US for procedural guidance (vascular access, regional anesthesia) and emergency point-of-care US (abdominal, chest wall and airway imaging). Of all these applications, only the training and certification requirements for perioperative TEE are well established....

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