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Monitoring during paediatric cardiac anaesthesia
1Department of Anaesthesia, University of British Columbia, British Columbia's Children's Hospital, Vancouver, Canada.
Insights
Paediatric cardiac anaesthesia monitoring is complex, involving routine and specialized techniques. This review updates on advancements in cardiac monitoring, emphasizing the crucial role of clinical assessment.
Area of Science:
- Pediatric Anesthesiology
- Cardiac Anesthesia
- Critical Care Medicine
Background:
- Pediatric anesthesia monitoring has grown complex, especially in cardiac cases.
- Congenital heart abnormalities, surgery, and cardiopulmonary bypass impact routine monitoring.
- Specialized monitoring is increasingly vital for patient care.
Purpose of the Study:
- To provide a comprehensive review of recent literature on pediatric cardiac anesthesia monitoring.
- To highlight advancements in both routine and specialized monitoring techniques.
- To identify emerging trends and potential future standards in the field.
Main Methods:
- Literature review of published materials on pediatric cardiac anesthesia monitoring.
- Focus on advancements in specialized monitoring areas like cerebral function, oxygenation, cardiac output, and coagulation.
- Emphasis on transesophageal echocardiography developments.
Main Results:
- Routine monitoring is significantly influenced by cardiac conditions, surgical procedures, and cardiopulmonary bypass.
- Specialized monitoring, including cerebral function, mixed venous oxygenation, cardiac output, and coagulation, is expanding.
- Transesophageal echocardiography has seen significant advancements and publications.
- Cerebral function monitoring remains controversial, requiring further research.
Conclusions:
- The review synthesizes current knowledge and future directions in pediatric cardiac anesthesia monitoring.
- Despite technological advancements, bedside clinical monitoring by physicians remains paramount.
- Further research is needed, particularly in cerebral function monitoring.
Abstract:
Monitoring of paediatric anaesthesia has become increasingly more complex in recent years and this is particularly true of cardiac anaesthesia. The purpose of this review is to give a comprehensive update of published material related to both routine and specialized cardiac monitoring. Routine monitoring can be particularly affected by the alterations of cardiac rhythm, blood flow, cardiac output and oxygenation which result from the congenital heart abnormalities themselves, the type of surgery undertaken and the effects of cardiopulmonary bypass. The use of specialized monitoring is becoming more widespread, particularly in the areas of cerebral function, mixed venous oxygenation, cardiac output measurement and coagulation. In the last five years, with the development of smaller probes, a great deal has been published on transoesophageal echocardiography. The use of the current monitors of cerebral function still remains controversial despite the need for a monitor of adequate brain perfusion, reflecting the need for a great deal of further research in this area. This review will concentrate on particular areas which have seen the most profound changes and on monitoring that may form the standards of tomorrow. Finally, amongst all the technology, it should not be forgotten that the most important clinical monitor is the bedside clinical monitoring of the physicians themselves.