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Intraoperative Monitoring

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Book cover Principles and Practice of Anesthesia for Thoracic Surgery

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Abstract

Continuous automated ST-segment analysis is especially important during thoracic surgery given the potential for cardiac ischemia, arrhythmias, pneumothorax, severe hypoxemia, and hemodynamic instability. Oxygenation during one-lung ventilation is determined by many factors including cardiac output, blood pressure, ventilation–perfusion matching, anesthetic effects on hypoxic pulmonary vasoconstriction, airway mechanics and reactivity, oxygen consumption, and preexisting pulmonary disease. Pulse oximetry with occasional intermittent arterial blood gas analysis provides warning of significant hypoxemia. The typical CO2 vs. time waveform, displayed on most anesthesia monitors, has characteristic intervals that represent different physiologic events during ventilation. Continuous breath-by-breath spirometry (monitoring of inspiratory and expiratory volumes, pressures, and flows) enables the early detection of a mal-positioned double-lumen tube and can reduce the potential for ventilatory-induced lung injury by guiding the optimization of ventilatory ­settings. Invasive arterial pressure monitoring is commonly used to assess beat-by-beat blood pressure and it can also be used to derive functional hemodynamic information such as systolic pressure variation (SPV) and pulse pressure variation (PPV). SPV and PPV measure related aspects of cardiorespiratory interaction and these variables can predict the ability to increase cardiac output with volume loading better than central venous pressure or pulmonary artery occlusion pressure. Minimally-invasive hemodynamic monitoring (such as the Esophageal Doppler, Arterial Pressure waveform-based devices, and/or central venous oximetry) coupled with goal-directed therapy care can improve outcomes by focusing on basic clinical questions such as: “is flow (cardiac output) adequate to meet global tissue demands?”

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Author information

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, MD Anderson Cancer Center, Houston, TX, USA

    Gabriel E. Mena MD

  2. Department of Anesthesiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA

    Karthik Raghunathan MD, MPH

  3. ICU Quality Improvement, Critical Care Division, Department of Medicine and Surgery, Baystate Medical Center, Springfield, MA, USA

    William T. McGee MD, MHA

  4. Tufts University School of Medicine, Boston, MA, USA

    William T. McGee MD, MHA

Authors
  1. Gabriel E. Mena MD
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  2. Karthik Raghunathan MD, MPH
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  3. William T. McGee MD, MHA
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Editor information

Editors and Affiliations

  1. University of Toronto, Staff Anesthesiologist, Professor of Anesthesia, Toronto, M5G 2C4, Ontario, Canada

    Peter Slinger, MD, FRCPC

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© 2011 Springer Science+Business Media, LLC

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Mena, G.E., Raghunathan, K., McGee, W.T. (2011). Intraoperative Monitoring. In: Slinger, MD, FRCPC, P. (eds) Principles and Practice of Anesthesia for Thoracic Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0184-2_19

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  • DOI: https://doi.org/10.1007/978-1-4419-0184-2_19

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-0183-5

  • Online ISBN: 978-1-4419-0184-2

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