monitoring of patients during anesthesia and surgery haim berkenstadt md director, department of...
TRANSCRIPT
Monitoring of Patients during Anesthesia and Surgery
Haim Berkenstadt MDDirector, Department of Anesthesiology
Deputy Director, The Israel Center for Medical Simulation
Sheba Medical Center, Tel Hashomer
April 2009
Agenda
Requisites from anesthesia monitoring
Physiological changes during anesthesia
Complications of anesthesia
Monitoring of specific physiological systems
Generic considerations of monitoring
Monitoring?
Physiological data
Relevant
On line measurement
Continuous measurement
Influence medical decision making
Improve patients safety
Cost effective
Physiological Changes During Anesthesia and Surgery
Respiratory Changes
Hypoventilation
Hypoxemia
Hemodynamic changes
Preload
Afterload
Contractility
Physiological Changes During Anesthesia and Surgery
Changes in neuromuscular function
Changes in fluids balance
Bleeding
ADH
Changes in heat exchange
Exposure
Vasodilatation
Complications of Anesthesia
Common
Damage to teeth
Nausea and vomiting
Pain
Hypothermia
Complications of Anesthesia
Life threatening
Esophageal intubation
Cardiac
Respiratory
Anesthesia machine malfunction
Post operative residual neuromuscular
blockade
Awareness during anesthesia
Anesthesia Monitoring System
ECG
ECG
Heart rate
Heart rhythm
Myocardial ischemia
Blood Pressure
Non invasive blood pressure
measurement
Invasive blood pressure measurement
Non Invasive Measurement
What do we measure?
Where to measure?
Cuff size?
Interval?
Invasive Blood Pressure Measurement
Pulse Oximetry
Oxygen saturation
Heart rate
Plethysmography
Capnography
Mechanically ventilated patient /
Spontaneously breathing patient
Side stream / Main stream
Capnography
Respiratory rate
End tidal CO2
Endotracheal intubation
Cardiac output
Temperature - Core Body Temperature
Thermoregulation under Anesthesia
Consequences of Hypothermia
Hemodynamic effects
Coagulation
Surgical wound infection
Cardiac morbidity
Metabolism of drugs
Shivering
Temperature Measurement
When?
Where?
Skin
Esophageal
Urine
Blood
Neuromuscular Monitoring
Nerve stimulator
Electrical stimulus
Measurement of motor response
Urine Output
Volume status
Increased urine output
Prevention of Awareness during Anesthesia
Prevention of Awareness during Anesthesia
Gas Analyzer
Ventilation
Ventilation
Invasive Monitoring Central Venous Pressure, Pulmonary Capillary Occlusion
Pressure, Cardiac Output, Intra-Cranial Pressure
Trans-esophageal Echocardiography
EEG
Monitoring Alarms
Adaptation to
Age and patients’ normal values
Borders of safety
Balance between
Safety
False alarms
Trends of Parameters
Documentation
Documentation
