An update on pediatric monitoring

Monitoring in pediatric anesthesia practice encompasses essentially the same spectrum of techniques and measurements as monitoring of adult patients, except that techniques are modified positively by the generally better health of children and negatively by conflicting anecdotes concerning how rapidly negative effects can occur in anesthetized children. As a consequence, progress has followed two general tracks: (1) cautious expansion of invasive techniques, such as arterial and central venous blood pressure monitoring and (2) more vigorous expansion of noninvasive techniques. Progress in the use of invasive techniques is affected by technical difficulties and fear of causing patient harm, while advances in noninvasive monitoring have been fueled by recognition of the inherent value of reliable and constant measurement of essential variables, such as peripheral oxygenation and end-tidal carbon dioxide tension. This article reviews both tracks, updating knowledge of invasive techniques and providing a discussion of less glamorous but more broadly useful noninvasive methods, such as automated blood pressure monitoring and pulse oximetry.