Modern Monitoring in Anesthesiology and Perioperative Care

Our current practice environment is daunting.Providing safe quality care using technology andreceiving feedback that didn’t even exist 15 years agoshould be easy, but it isn’t. The plethora of informationand the number and variety of monitors available foruse has increased in an almost exponential fashion. OnOctober 27, 2019, a PubMed search of “noninvasivemonitoring of cardiac output” yielded 809 references, aGoogle search for “anesthesiology guidelines” 25,700references, and there are at least 9 different technologiesfor monitoring of cardiac output incorporated intocommercially available products.This book aims to be different than other monitoringbooks and focuses on the “practical.” Chapters onstatistics and electronic distraction are unique andprovide a framework for evaluation of all monitors,and reveal the risk that too much information poses tothe care that we provide. Other chapters focus on the“why” monitoring a certain variable may be advantageous,the basics of “how” the monitor works, and“what” is the evidence of the impact on patient outcome.A basic theme of the chapters is that just becausewe can do something does not mean we should, andsometimes less may be more, but a working knowledgeof the whys, hows, and whats of modern monitoringin anesthesiology and perioperative care willallow every provider to optimize their patient’s safetyand the quality of care they provide. Statistics used to assess monitors and monitoring application / Lester A. H. Critchley -- Multimodal neurological monitoring / Samson Zarbiv, Erica Fagleman, and Neha S. Dangayach -- Cerebral oximetry / Benjamin Salter and Elvera Baron -- Oxygen reserve index / Andrew B. Leibowitz -- Point-of-care transesophageal echocardiography / Ronald A. Kahn -- Point-of-care transthoracic echocardiography / Julia Sobel and Oliver Panzer -- Point of care lung ultrasound / Zachary Kuschner and John Oropello -- Point of care ultrasound : determination of fluid responsiveness / Subhash Krishnamoorthy and Oliver Panzer -- Point of care abdominal ultrasound / Shaun L. Thompson and Daniel W. Johnson -- Noninvasive measurement of cardiac output / Sam Gilliland, Robert H. Thiele, and Karsten Bartels -- Assessing intravascular volume status and fluid responsiveness : a non-ultrasound approach / David S Beebe -- Assessment of extravascular lung water / Torsten Loop -- Point of care hematology / Jacob Raphael, Liza Enriquez, Lindsay Regali, and Linda Shore-Lesserson -- Assessment of intraoperative blood loss / Kyle James Riley and Daniel Katz -- Respiratory monitoring in low-intensity settings / Andrew B. Leibowitz and Adel Bassily-Marcus -- The electronic health record as a monitor for performance improvement / David B. Wax -- Future monitoring technologies : wireless, wearable and nano / Ira S. Hofer and Myro Figura -- Downside and risks of digital distractions / Peter Papadakos, Albert Yu Cover......Page 1 Modern Monitoring in Anesthesiology and Perioperative Care ......Page 4 Copyright ......Page 5 Contents ......Page 6 Contributors ......Page 7 Preface ......Page 10 1 Statistics Used to Assess Monitors and Monitoring Applications......Page 12 2 Multimodal Neurological Monitoring......Page 21 3 Cerebral Oximetry......Page 31 4 The Oxygen Reserve Index......Page 41 5 Point-of-Care Transesophageal Echocardiography......Page 46 6 Point-of-Care Transthoracic Echocardiography......Page 66 7 Point-of-Care Lung Ultrasound......Page 78 8 Point-of-Care Ultrasound: Determination of Fluid Responsiveness......Page 91 9 Point-of-Care Abdominal Ultrasound......Page 103 10 Noninvasive Measurement of Cardiac Output......Page 111 11 Assessing Intravascular Volume Status and Fluid Responsiveness: A Non-Ultrasound Approach......Page 120 12 Assessment of Extravascular Lung Water......Page 128 13 Point-of-Care Hematology......Page 134 14 Assessment of Intraoperative Blood Loss......Page 150 15 Respiratory Monitoring in Low-Intensity Settings......Page 159 16 The Electronic Health Record as a Monitor for Performance Improvement......Page 165 17 Future Monitoring Technologies: Wireless, Wearable, and Nano......Page 175 18 Downside and Risks of Digital Distractions......Page 184 Index ......Page 191 Plate......Page 200 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.