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Respiratory monitoring utilizing pulse oximetry and expired carbon dioxide (CO2) measurement has been an operating room standard since the 1980s. Post-anesthesia and intensive care units adopted pulse oximetry shortly thereafter and only recently have embraced expired CO2 monitoring. However, there remains a need for monitoring the respiratory function of patients in low-intensity hospital environments (i.e., other than operating rooms, post-anesthesia care units, or intensive care units), since they frequently experience respiratory compromise that may progress, require tracheal intubation, and may deteriorate to cardiopulmonary arrest. This is especially true in patients with obesity, obstructive sleep apnea, and opioid administration, which are common risk factors. Monitoring for respiratory compromise in low-intensity environments, however, is challenging. This chapter addresses the use of pulse oximetry, expired CO2, photoplethysmography, bioimpedance, and acoustic monitoring in these settings.
Pulse oximetry was one of the most quickly and widely adopted bedside monitors in the operating room and intensive care unit. Improvements to it over time have increased its reliability and extended its applications. Advanced warning of critical oxygen desaturation, especially during airway management, is a goal of a new pulse oximetry function termed “oxygen reserve index.” This function in its current state of development would alarm when the SpO2 is> 99% and predict the decrease to an SpO2 < 98% in a time frame (e.g., 30–-40 seconds) that might impact management. This chapter reviews this function, the clinical investigations published thus far, and the possible benefits and difficulties in utilizing such an alarm.
Close monitoring of patients during anesthesia is crucial for ensuring positive treatment outcomes and patient safety. The increasing availability of new technologies and the repurposing of older monitors means more patient data is at anesthesiologists' fingertips than ever before. However, this flood of options can be overwhelming. A practical resource for understanding this array of clinical monitoring options in anesthesia, this important text focuses on real-world applications in anesthesia and perioperative care. Reviewing the evidence for improved patient outcomes for monitoring technology, neurological monitoring, echocardiography systems and ultrasound are amongst the techniques covered in a head-to-toe approach. Statistics used by manufacturers to gain approval for their technology are discussed, as well as the under-appreciated risks associated with monitoring such as digital distraction. Future monitoring technologies including wearable systems are explored in depth. Focusing on applied practice, this book is an essential text for front-line healthcare professionals in anesthesia.
Monitoring in Anesthesia and Perioperative Care is a practical and comprehensive resource documenting the current art and science of perioperative patient monitoring, addressing the systems-based practice issues that drive the highly regulated health care industry of the early twenty-first century. Initial chapters cover the history, medicolegal implications, validity of measurement and education issues relating to monitoring. The core of the book addresses the many monitoring modalities, with the majority of the chapters organized in a systematic fashion to describe technical concepts, parameters monitored, evidence of utility complications, credentialing and monitoring standards, and practice guidelines. Describing each device, technique and principle of clinical monitoring in an accessible style, Monitoring in Anesthesia and Perioperative Care is full of invaluable advice from the leading experts in the field, making it an essential tool for every anesthesiologist.
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