Perioperative Point-of-Care Ultrasound and Transesophageal Echocardiography in Resource- Limited Settings-A Focus on Nepal and Bangladesh.

The use of point-of-care ultrasound (POCUS) and transesophageal echocardiography (TEE) in the perioperative and critical care setting is increasing worldwide. This increase has been driven by increasing educational opportunities and technologic advances. Nepal and Bangladesh are resource-limited countries where concerted efforts have been made to increase training in POCUS or TEE in the perioperative and critical care settings. This paper's focus is to present the current state of use and international efforts to improve education and skills in perioperative POCUS and TEE in Nepal and Bangladesh. The authors also examine the challenges to improving and expanding ultrasound use in the perioperative environment in resource- limited environments in general, using the Nepalese and Bangladeshi experiences as case studies. The authors have held multiple short courses in POCUS or TEE in Nepal and Bangladesh over the past several years. The authors found a high level of interest in learning POCUS and TEE skills among participants. They encountered challenges with maintaining continuing education and quality assurance for participants after the courses. They also identified barriers to incorporating ultrasound into daily practice in local hospitals. An increasing prevalence of cardiovascular disease will increase the need for diagnostic strategies for patients worldwide, including the use of POCUS and TEE, to manage patients in the perioperative and critical care settings. The courses held in Nepal and Bangladesh may serve as models to expand educational opportunities in POCUS and perioperative TEE in resource-limited settings.

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