Monitoring of Patients during Anesthesia and Surgery Haim Berkenstadt MD Director, Department of Anesthesiology Deputy Director, The Israel Center for.

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Presentation transcript:

Monitoring of Patients during Anesthesia and Surgery Haim Berkenstadt MD Director, 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

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

Gas Analyzer

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

Thank you