Cvs Monitoring In Anesthesia

CVS MONITORING IN ANESTHESIA


Introduction:

Methods:

  • Non-invasive.
  • Invasive

Non-invasive methods:

ECG:

  • Excellent monitor to detect arrhythmia, ischemia/cardiac arrest. 
  • Arrhythmia detection – By lead II.
  • Ischemia detection – By lead V2.

Non-invasive B.P. (NIBP):

  • NIBP instruments measure BP automatically at regular interval. 
  • Important factor – Cuff size.
  • Should cover 2/3rd of arm length.
  • Too large cuff will under-read actual value.
  • Too small cuff will over-read actual value

Transesophageal echocardiography:

2-dimensional TEE:

  • Rapid & more sensitive indicator of myocardial ischemia than ECG. 
  • Detects myocardial ischemia & air embolism in peri-operative period. 
  • Detects regional wall motion abnormality.
  • Decreased systolic wall thickening – More reliable index for ischemia than endocardial wall motion abnormality.

Invasive methods:

1. Invasive blood pressure (IBP):

  • Recorded by transducer inside artery. 
  • Radial artery – Most common artery.
  • Dorsal pedis artery – In infants.

Intra-arterial cannulation:

  • Arterial blood sampling (ABG measurement).
  • Intra-arterial BP measurement.
  • Drug injection.
  • Blood transfusion.

2. Central venous pressure monitoring (CVP):

  • Most commonly in right internal jugular vein. 
  • Measured in subclavian, basilic & femoral veins. 
  • Normal CVP = 3-10 cm of H20 (2-8 mm Hg).

Increased CVP:

  • CHF, IPPV with PEEP Valsalva maneuver.

Decreased CVP:

  • Venodilators (nitroprusside).

Indications:

  • Estimation of intravascular volume – Guide to fluid therapy mainly blood/plasma transfusion.

Complication: 

  • Air embolism, hemothorax, sepsis & trauma to carotid artery (cause pseudoaneurysm).

3. Pulmonary artery catheterization:

  • Catheter insertion into pulmonary artery. 
  • Catheter used – Swan-Ganz catheter.

Uses: 

  • Direct simultaneous measurement of pressure in right atrium, right ventricle & pulmonary artery.
  • Cardiac output.
  • Oxygen saturation of mixed venous blood – Pulmonary artery (best site).

Exam Important

  • Non-invasive B.P. (NIBP) important factor is cuff size & should cover 2/3rd of arm length, too large cuff will under-read actual value & too small cuff will over-read actual value
  • Transesophageal echocardiography (2-dimensional TEE) is rapid & more sensitive indicator of myocardial ischemia than ECG. 
  • 2-dimensional TEE is detecting myocardial ischemia & air embolism in peri-operative period & detects regional wall motion abnormality.
  • 2-dimensional TEE is decreased systolic wall thickening is more reliable index for ischemia than endocardial wall motion abnormality.
  • Invasive blood pressure (IBP) is usually recorded in most common artery is radial artery.
  • Central venous pressure monitoring (CVP) is normal CVP = 3-10 cm of H20 (2-8 mm Hg).
  • CHF, IPPV with PEEP & Valsalva maneuver are conditions increasing CVP.
  • Venodilators (nitroprusside) is decreasing CVP.
  • Estimation of intravascular volume is a guide to fluid therapy mainly blood/plasma transfusion.
  • Complications of CVP are air embolism, hemothorax, sepsis & trauma to carotid artery (cause pseudoaneurysm).
  • Pulmonary artery catheterization is done by Swan-Ganz catheter.
  • Pulmonary artery catheterization measures direct simultaneous measurement of pressure in right atrium, right ventricle & pulmonary artery.
  • Pulmonary artery catheterization is used for measurement of cardiac output & measuring oxygen saturation of mixed venous blood.
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