Masui. The Japanese journal of anesthesiology
-
Coagulation disorders often occur perioperatively and monitoring of blood coagulation should be fast and adequate to treat these disorders to protect patients from massive bleeding. Control of hemostasis is one of the main issues in major surgeries. Coagulation test results from a central laboratory may delay making such a perioperative decision. ⋯ Both prothrombin time (PT) and activated clotting time (ACT) are very useful and popular, but also criticized because they can be monitored only until fibrin formation. On the other hand, viscoelastic monitorings of whole blood, are able to estimate fibrin formation, clot fixation, platelet function and fibrinolysis. In this review article, among variable perioperative POCMs of blood coagulation, three thromboelastographic monitorings, such as TEG ROTEM, and Sonoclot as well as PT and ACT, are described along with their utilities and limits to examine perioperative coagulation.
-
It is more than 60 years since averaged somatosensory evoked potentials (SEPs) were devised. During this period, other evoked potentials including spinal cord evoked potentials and motor evoked potentials (MEPs) were developed. ⋯ The combination of these evoked potentials (multimodality monitoring) has been demonstrated to be sensitive and specific for detecting intraoperative neurologic injury during spine surgery. Although there is still a low level of evidence that intraoperative evoked potentials reduce the rate of new or worsened perioperative neurologic deficits, it is recommended to monitor MEP for thoracoabdominal aortic surgery and multimodal evoked potentials including at least spinal cord evoked potentials and MEP for spine surgery, when the spinal cord is considered to be at risk.
-
Less invasive measuring procedures for hemodynamic status and function are increasingly being used. Surgical patients are frequently undifferentiated, need accurate risk assessment and stratification, while their need for diagnosis and therapy is often time-critical. ⋯ Pulmonary artery catheters, transesophageal echocardiography, pressure pulse waveform analysis, and other less invasive monitoring techniques all are potentially effective for diagnosis and hemodynamic monitoring. This article provides information on the usefulness and limitations of recent circulatory monitoring procedures.
-
The role of various monitors contributing to achieving and standardizing safety has been increasing in the management of general anesthesia. In particular, sufficient oxygenation is one of the most basic requirements to ensure the safety of patients under general anesthesia. In this report, pulse oximetry, mixed venous oxygen saturation, and central venous oxygen saturation are reexamined as monitors, based on evaluation of the respiratory system and tissue oxygenation, in order to evaluate their usefulness in measurements. Regarding pulse oximeters, the models with added functions are introduced, and in this article mixed venous and central venous oxygen saturation, the early goal-directed therapy (EGDT) and the core of the Surviving Sepsis Campaign (SSC) guidelines from 2008, are examined.
-
The goals of monitoring are to improve the safety of perioperative care and to improve patient's outcome. Various invasive and non-invasive monitors are currently used. ⋯ We must continue to improve the functions of monitors. The existence of a well-trained competent anesthesiologist at bedside is essential to integrate all the information gained by five senses, the monitors, blood tests and close communication with surgeons on top of deep understanding of the patient's preoperative status.