Outcome impact of hemodynamic and depth of anesthesia monitoring during major cancer surgery: a before –after study

AbstractHemodynamic and depth of anesthesia (DOA) monitoring are used in many high-risk surgical patients without well-defined indications and objectives. We implemented monitoring guidelines to rationalize hemodynamic and anesthesia management during major cancer surgery. In early 2014, we developed guidelines with specific targets (Mean arterial pressure  >  65 mmHg, stroke volume variation <  12%, cardiac index >  2.5 l min−1 m−2, central venous oxygen saturation  >  70%, 40 <  bispectral index <  60) for open abdominal cancer surgeries >  2 h. Pre-, intra-, and post-operative data were collected from our electronic medical record database and compared before (March–August 2013) and after (March–August 2014) guideline implementation. A total of 596 patients were studied, 313 before (Before group) and 283 after (After group) gu ideline implementation. The two groups were comparable for age, ASA score, physiological P-POSSUM score, and surgery duration, but the operative P-POSSUM score was higher in the after group (20 vs. 18, p = 0.009). The use of cardiac output, central venous oxygen saturation and DOA monitoring inc reased from 40 to 61%, 20 to 29%, and 60 to 88%, respectively (all p-values <  0.05). Intraoperative fluid volumes decreased (16.0 vs. 14.5 ml kg−1 h−1, p  = 0.002), whereas the use of inotropes increased (6 vs. 11%, p = 0.022). Postoperative delirium (16 vs. 8%, p = 0...
Source: Journal of Clinical Monitoring and Computing - Category: Information Technology Source Type: research