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Ultrasound has long been linked to regional anaesthesia, but over the last decades, its reach has changed spectacularly. Smaller, high-resolution, and increasingly affordable machines have brought ultrasound from the radiology department to the operating theatre, recovery room, emergency and intensive care unit. The soul of “point-of-care” lies in its ability to integrate acquisition, interpretation and medical decision (I-AIM) taking at bedside without delay. This capacity reflects perfectly the transformation of the anaesthesiologist into a perioperative physician. As the frontiers between anaesthesia, perioperative medicine, and critical care soften, PoCUS provides a single common diagnostic and procedural language.

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The papers in this special issue all explore the remarkable span of perioperative PoCUS applications.

Gastric ultrasound has emerged as an indispensable method for evaluating aspiration risk. Beyond adherence to fasting guidelines, real-time assessment of gastric content and volume enables individualised anaesthesia planning and airway management, the perfect example of a shift from population-based to patient-specific anaesthesia care, more especially with the explosive use of GLP-1 agonists.

Lung ultrasound has also transformed respiratory assessment. Capable of detecting pneumothorax, pleural effusion, atelectasis, and pulmonary oedema with high sensitivity, it often challenges traditional chest X-rays in speed and accuracy. Intraoperatively, it assists with recruitment and ventilatory management; postoperatively, it enables early detection of respiratory complications.

The use of transthoracic echocardiography ( TTE ) and rescue transoesophageal echocardiography ( rTEE ) highlights the growth of cardiovascular perioperative ultrasound. Anaesthesiologists can illuminate ventricular function, preload status, and valvular integrity—insights critical for managing haemodynamic instability. The use of rTEE offers the potential to optimize chest compressions during cardiac arrest.

Airway ultrasound represents another fast-tracking application that visualizes upper airway structures, confirms endotracheal tube placement, and guides percutaneous tracheostomy in difficult airway scenarios.

In obstetric anaesthesia, patients often are a special challenge for the anaesthetic community and PoCUS adds a valuable layer of maternal and foetal safety and informed interventions. Differentiating physiological changes of pregnancy from pathology, the prediction and management of the anticipated difficult airway in pregnancy, assessment for free fluid or foetal viability can all guide decision-making when other imaging modalities are unavailable or contraindicated.

Implementing PoCUS requires structured education, support and cultural change. The contribution “From Probe to Practice: Implementing Point-of-Care Ultrasound in Anaesthesiology” in this issue examines these dimensions in depth.