ANESTHESIOLOGY FAST REVIEW

ANESTHESIOLOGY_FAST_REVIEWKAPAK1-0-25

MONITORS IN ANESTHESIA

Pınar Kırdemir

Ankara Bilkent City Hospital, Department of Anesthesiology and Reanimation, Ankara, Türkiye

Kırdemir P. Monitors in Anesthesia. In: Kazancı D, editor. Anesthesiology Fast Review. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.523-533.

ABSTRACT

  • Anesthesia and surgery lead to significant physiological changes, making continuous monitoring essential for detecting deviations and ensuring patient safety.
  • Pulse oximetry and capnography are vital for monitoring oxygen saturation and carbon dioxide levels, respectively, and for confirming airway placement during surgery.
  • Monitoring airway pressures and volumes is crucial for identifying respiratory abnormalities and ensuring proper ventilation.
  • Blood pressure, heart rate, and circulatory function are assessed using both non-invasive and invasive methods, with a focus on ensuring accurate measurements in high-risk surgeries.
  • Electrocardiography is used to detect arrhythmias and ischemic changes during surgery, with specific lead combinations enhancing intraoperative ischemia detection.
  • Electroencephalography, electromyography, and evoked potential monitoring assess neural function, particularly in surgeries involving neural structures, to detect potential injuries.
  • Fluid management is crucial for maintaining normovolemia, ensuring proper tissue perfusion, and preventing complications from fluid imbalances during surgery.
  • Dynamic hemodynamic parameters guide fluid therapy in surgeries with significant fluid shifts and/or blood loss, optimizing patient outcomes and preventing complications.

Keywords: Intraoperative monitoring; Blood pressure monitors; Hemodynamic monitoring; Neurophysiologic monitoring; Intraoperative neurophysiologic monitoring; Fluid therapy

Referanslar

  1. Kerslake I, Kelly F. Uses of capnography in the critical care unit. Bja Education. 2017;17(5):178-183. [Crossref]
  2. Morgan G, Mikhail M, Murray M. Respiratory physiology: The effects of anesthesia. Clinical anesthesiology.2006;4:537-570. [Link]
  3. Wahba R, Tessler M. Misleading end-tidal CO 2 tensions. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 1996;43:862-866. [Crossref]  [PubMed]
  4. Whitesell R, Asiddao C, Gollman D, Jablonski J. Relationship between arterial and peak expired carbon dioxide pressure during anesthesia and factors influencing the difference. Anesthesia & Analgesia. 1981;60(7):508-512. [Crossref]
  5. Ard JL, Kendale S. Searching for baseline blood pressure: a comparison of blood pressure at three different care points. Journal of Clinical Neuroscience. 2016;34:59-62. [Crossref]  [PubMed]
  6. Kallioinen N, Hill A, Horswill MS, Ward HE, Watson MO. Sources of inaccuracy in the measurement of adult patients' resting blood pressure in clinical settings: a systematic review. Journal of hypertension. 2017;35(3):421-441. [Crossref]  [PubMed]  [PMC]
  7. David W, Lin H, Andrew L. Invasive and Concomitant Noninvasive Intraoperative blood pressure monitoring. Anesthesiology. 2011;115(5) [Crossref]  [PubMed]
  8. Davis JW, Davis IC, Bennink LD, Bilello JF, Kaups KL, Parks SN. Are automated blood pressure measurements accurate in trauma patients? Journal of Trauma and Acute Care Surgery. 2003;55(5):860-863. [Crossref]  [PubMed]
  9. Li-wei HL, Saeed M, Talmor D, Mark R, Malhotra A. Methods of blood pressure measurement in the ICU. Critical care medicine. 2013;41(1):34-40. [Crossref]  [PubMed]  [PMC]
  10. Kouz K, Wegge M, Flick M, et al. Continuous intra-arterial versus intermittent oscillometric arterial pressure monitoring and hypotension during induction of anaesthesia: the AWAKE randomised trial. British Journal of Anaesthesia. 2022;129(4):478-486. [Crossref]  [PubMed]
  11. O'Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clinical infectious diseases. 2011;52(9):e162-e193. [Crossref]  [PubMed]  [PMC]
  12. Brzezinski M, Luisetti T, London MJ. Radial artery cannulation: a comprehensive review of recent anatomic and physiologic investigations. Anesthesia & Analgesia. 2009;109(6):1763-1781. [Crossref]  [PubMed]
  13. Barone JE, Madlinger RV. Should an Allen test be performed before radial artery cannulation? Journal of Trauma and Acute Care Surgery. 2006;61(2):468-470. [Crossref]  [PubMed]
  14. Hamon M, Pristipino C, Di Mario C, et al. Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions andWorking Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology. EuroIntervention. 2013;8(11):1242-51. [Crossref]  [PubMed]
  15. Bertrand OF, Carey PC, Gilchrist IC. Allen or no Allen: that is the question! : American College of Cardiology Foundation Washington, DC; 2014. p. 1842-1844. [Crossref]
  16. Jarvis MA, Jarvis CL, Jones PR, Spyt TJ. Reliability of Allen's test in selection of patients for radial artery harvest. The Annals of thoracic surgery. 2000;70(4):1362-1365. [Crossref]  [PubMed]
  17. Landesberg G, Mosseri M, Wolf Y, Vesselov Y, Weissman C. The probability of detecting perioperative myocardial ischemia in vascular surgery by continuous 12-lead ECG. Anesthesiology. 2002;96:264. [Crossref]  [PubMed]
  18. London MJ, Hollenberg M, Wong MG, et al. Intraoperative myocardial ischemia: localization by continuous 12-lead electrocardiography. Anesthesiology. 1988;69(2):232-241. [Crossref]  [PubMed]
  19. Lall RR, Lall RR, Hauptman JS, et al. Intraoperative neurophysiological monitoring in spine surgery: indications, efficacy, and role of the preoperative checklist. Neurosurgical focus. 2012;33(5):E10. [Crossref]  [PubMed]
  20. Weinzierl MR, Reinacher P, Gilsbach JM, Rohde V. Combined motor and somatosensory evoked potentials for intraoperative monitoring: intra-and postoperative data in a series of 69 operations. Neurosurgical review. 2007;30:109-116. [Crossref]  [PubMed]
  21. Chui J, Manninen P, Valiante T, Venkatraghavan L. The anesthetic considerations of intraoperative electrocorticography during epilepsy surgery. Anesthesia & Analgesia. 2013;117(2):479-486. [Crossref]  [PubMed]
  22. Deletis V, Sala F. Intraoperative neurophysiological monitoring of the spinal cord during spinal cord and spine surgery: a review focus on the corticospinal tracts. Clinical neurophysiology. 2008;119(2):248-264. [Crossref]  [PubMed]
  23. Frost EA. Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals. Journal of Neurosurgical Anesthesiology. 2012;24(3):226-227. [Crossref]
  24. Jameson LC, Janik DJ, Sloan TB. Electrophysiologic monitoring in neurosurgery. Anesthesiology clinics. 2007;25(3):605-630. [Crossref]  [PubMed]
  25. Sloan MA. Prevention of ischemic neurologic injury with intraoperative monitoring of selected cardiovascular and cerebrovascular procedures: roles of electroencephalography, somatosensory evoked potentials, transcranial Doppler, and near-infrared spectroscopy. Neurologic clinics. 2006;24(4):631-645. [Crossref]  [PubMed]
  26. Jameson LC, Sloan TB. Monitoring of the brain and spinal cord. Anesthesiology Clinics of North America. 2006;24(4):777-791. [Crossref]  [PubMed]
  27. Holland NR. Intraoperative electromyography. Journal of clinical neurophysiology. 2002;19(5):444-453. [Crossref]  [PubMed]
  28. Hamilton DK, Smith JS, Sansur CA, et al. Rates of new neurological deficit associated with spine surgery based on 108,419 procedures: a report of the scoliosis research society morbidity and mortality committee. Spine. 2011;36(15):1218-1228. [Crossref]  [PubMed]
  29. Kumar A, Bhattacharya A, Makhija N. Evoked potential monitoring in anesthesia and analgesia. Anaesthesia. 2000;55(3):225-241. [Crossref]  [PubMed]
  30. Toleikis JR, Pace C, Jahangiri FR, Hemmer LB, Toleikis SC. Intraoperative somatosensory evoked potential (SEP) monitoring: an updated position statement by the American Society of Neurophysiological Monitoring. Journal of clinical monitoring and computing. 2024;38(5):1003-1042. [Crossref]  [PubMed]  [PMC]
  31. Banoub M, Tetzlaff JE, Schubert A. Pharmacologic and physiologic influences affecting sensory evoked potentials: implications for perioperative monitoring. Anesthesiology. 2003;99(3):716-737. [Crossref]  [PubMed]
  32. Legatt AD. Mechanisms of intraoperative brainstem auditory evoked potential changes. Journal of clinical neurophysiology. 2002;19(5):396-408. [Crossref]  [PubMed]
  33. Thirumala PD, Habeych ME, Crammond DJ, Balzer JR. Neurophysiologic intraoperative monitoring of olfactory and optic nerves. Journal of Clinical Neurophysiology. 2011;28(6):538-542. [Crossref]  [PubMed]
  34. Sasaki T, Itakura T, Suzuki K, et al. Intraoperative monitoring of visual evoked potential: introduction of a clinically useful method. Journal of neurosurgery. 2010;112(2):273-284. [Crossref]  [PubMed]
  35. Kodama K, Goto T, Sato A, Sakai K, Tanaka Y, Hongo K. Standard and limitation of intraoperative monitoring of the visual evoked potential. Acta neurochirurgica. 2010;152:643-648. [Crossref]  [PubMed]
  36. MacDonald DB. Intraoperative motor evoked potential monitoring: overview and update. Journal of clinical monitoring and computing. 2006;20:347-377. [Crossref]
  37. Shin CH, Long DR, McLean D, et al. Effects of intraoperative fluid management on postoperative outcomes: a hospital registry study. Annals of surgery. 2018;267(6):1084-1092. [Crossref]  [PubMed]
  38. Thacker JK, Mountford WK, Ernst FR, Krukas MR, Mythen MMG. Perioperative fluid utilization variability and association with outcomes: considerations for enhanced recovery efforts in sample US surgical populations. Annals of surgery. 2016;263(3):502-510. [Crossref]  [PubMed]
  39. Zarbock A, Koyner JL, Hoste EA, Kellum JA. Update on perioperative acute kidney injury. Anesthesia & Analgesia. 2018;127(5):1236-1245. [Crossref]  [PubMed]
  40. Chappell D, Jacob M, Hofmann-Kiefer K, Conzen P, Rehm M. A rational approach to perioperative fluid management. Anesthesiology. Oct 2008;109(4):723-40. [Crossref]  [PubMed]
  41. Brandstrup B. Fluid therapy for the surgical patient. Best practice & research Clinical anaesthesiology. 2006;20(2):265-283. [Crossref]  [PubMed]
  42. Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery. Anesthesia & Analgesia. 2005;101(2):601-605. [Crossref]  [PubMed]
  43. Magder S. Fluid status and fluid responsiveness. Current opinion in critical care. 2010;16(4):289-296. [Crossref]  [PubMed]
  44. Perel A. Using Dynamic Variables to Guide Perioperative Fluid Management. Anesthesiology. Oct 1 2020;133(4):929-935. [Crossref]  [PubMed]
  45. Thiele RH, Bartels K, Gan TJ. Inter-device differences in monitoring for goal-directed fluid therapy. Can J Anaesth. Feb 2015;62(2):169-81. [Crossref]  [PubMed]