cardio vascular monitoring, anesthesia
Post on 12-Feb-2017
Embed Size (px)
Presenter: Dr. Rashmit ShresthaModerator : Dr. Dipesh Man Singh
Introduction Although electronic devices constitute crucially important, the physician’s sense offer an integrated, panoramic view of the patient’s conditions
Inspection, Palpation and Auscultation are the cornerstones of the physical examination, they are also fundamental to perioperative CV monitor
STETHOSCOPEIt provides simple and reliable means of continuous monitoring of heart and breath sound.
Esophageal stethoscope facilitates temperature, clear breath and heart sound.
Heart Rate (HR) Monitoring
• The ECG is the most common method used in the OR.
• Accurate detection of the R wave and measurement of R-R wave interval serve as the basis from which digitally displayed values are derived and periodically updated.
Pulse Rate (PR) MonitoringHR from ECG tracePR from pulse oximeter plethysmograph or arterial blood pressure monitor.
Pulse Deficit = PR < HRSeen in Atrial Fibrillation, electromechanical dissociation or pulseless electrical activity ( e.g. cardiac tamponade, extreme hypovolemia).
Arterial Blood Pressure Monitoring
• A. Indirect Cuff Devices
• B. Direct Arterial Cannulation
Indirect measurement of Arterial BP
• Sphygmomanometer, first described by Riva Rocci in 1896.
• Arm encircling inflatable elastic cuff
• Rubber bulb to inflate the cuff pressure
• Radial artery palpated as pressure increased in cuff
• Mercury manometer.• Identifying ONLY systolic
blood pressure !
• Detecting both systolic and diastolic pressure became possible with the description of the auscultatory method of Blood Pressure measurement by Korotkoff in 1905.
Korotkoff sounds• Complex series of audible frequencies produced
by turbulent flow beyond the partially occluding cuff.
• Phase I : sound heard – systolic pressure• Phase II & III : sound character changes• Phase IV: becomes muffled• Phase V : absent • Diastolic Blood pressure at Phase IV & V
A well fitted cuff bladder that extends to 40% of arm circumference and 80% of length of the upper arm
Automated Intermittent Techniques• Automated noninvasive blood
pressure(NIBP) devices are standard equipment in most critical care settings because they provide frequent, regular pressure measurement, free the operator to perform other vital clinical duties, provide audible alarms, and can transfer data to a computerized information system.
Automated NIBP• Based on oscillometry
(Marey,1876) • Variation in cuff pressure
resulting from arterial pulsations during cuff deflation sensed by monitor
• Pressure at which peak amplitude of arterial pulsations occur, corresponds closely to direct measured MAP
• SBP and DBP are derived from proprietary formulas
• SBP and DBP are less reliable than MAP
Complications of NIBP Measurement• Pain• Petechiae and ecchymoses• Limb edema• Venous stasis and thrombophlebitis• Peripheral neuropathy• Compartment syndrome
Direct Measurement of Arterial BP• Indication for Arterial Cannulation– Continuous, real-time BP monitoring– Planned pharmacological or mechanical
cardiovascular manipulation– Repeated blood sampling– Failure or indirect arterial BP measurement – Supplementary diagnostic information from the
Percutaneous Radial Artery Cannulation
• Radial artery(RA) is the most common site.
• Before attempting RA cannulation, assessment of the adequacy of collateral flow to the hand is performed by modified Allen test.
Arterial line insertion
Alternative Arterial Pressure Monitoring Sites
• Ulnar artery• Brachial artery• Axillary arteryFemoral arteryLess commonly used:Dorsalis pedisPosterior tibialSuperficial temporal arteries
Complications of Direct Arterial Pressure Monitoring
• Distal Ischemia, pseudoaneurysm, arteriovenous fistula
• Hemorrhage• Arterial embolization• Infection• Peripheral neuropathy• Misinterpretation of data• Misuse of equipment.
Central Venous Pressure Monitoring• Indications for Central Venous CannulationCVP monitoringPulmonary artery catherterization and monitoringTransvenous cardiac pacingTemoporary hemodialysisDrug adminstration : Concentrated vasoactive drugs, hyperalimentation, chemotherapy etcRapid infusions of fluids Aspiration of air emboliInadequate peripheral intravenous accessSampling site for repeated blood testing
Central Venous Catheterization (Rt. IJV)
Atrial Fibrillation, absence of a wave, prominent c wave, preserved x and y
Complications of Central Venous Pressure Monitorng
• Mechanical : – Vascular injury : arterial, venous, cardiac tamponade• Respiratory compromise :- Airway compression from hematoma, Pneumothorax• Nerve injury• Arrhythmias • Thromboembolism • Infections • Misinterpretation of data• Misuse of equipment
THANK YOU !
References1. Miller’s Anesthesia, 8th Edition, Cardiovascular monitoring,
page 1345-2. https://en.wikipedia.org/wiki/Korotkoff_sounds3. https://www.youtube.com/watch?v=8xpKr1t7YQE4. Morgan and Mikhail’s Clinical Anesthesia. 5th Editions.