Best practice & research clinical anaesthesiology: Advances in haemodynamic monitoring for the perioperative patient: Perioperative cardiac output monitoring

Publication date: Available online 22 July 2019Source: Best Practice &Research Clinical AnaesthesiologyAuthor(s): Berthold Bein, Jochen RennerLess invasive or even completely non-invasive haemodynamic monitoring technologies have evolved during the last decades. Even established, invasive devices such as the pulmonary artery catheter and transpulmonary thermodilution have still an evidence-based place in the perioperative setting, albeit only in special patient populations. Accumulating evidence suggests to use continuous haemodynamic monitoring, especially flow-based variables such as stroke volume or cardiac output to prevent occult hypoperfusion and, consequently, decrease morbidity and mortality perioperatively. However, there is still a substantial gap between evidence provided by randomised trials and the implementation of haemodynamic monitoring in daily clinical routine. Given the fact that perioperative morbidity and mortality are higher than anticipated and anaesthesiologists are in charge to deal with this problem, the recent advances in minimally invasive and non-invasive monitoring technologies may facilitate more widespread use in the operating theatre, as in addition to costs, the degree of invasiveness of any monitoring tool determines the frequency of its application, at least perioperatively. This review covers the currently available invasive, non-invasive and minimally invasive techniques and devices and addresses their indications and limitations.
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research

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Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research
Publication date: Available online 22 July 2019Source: Best Practice &Research Clinical AnaesthesiologyAuthor(s): Berthold Bein, Jochen RennerAbstractLess invasive or even completely non-invasive haemodynamic monitoring technologies have evolved during the last decades. But even established, invasive devices such as the pulmonary artery catheter and transpulmonary thermodilution have still an evidence-based place in the perioperative setting, albeit only in special patient populations. Accumulating evidence suggests to use continuous haemodynamic monitoring, specifically flow-based variables such as stroke volume or ca...
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research
AbstractAssessment of right ventricular (RV) function is crucial since RV failure with a reduced cardiac output (CO) is associated with compromised outcome in cardiac surgery. Echocardiographic evaluation of RV function is commonly used, but a reduction in tricuspid annular plane systolic excursion (TAPSE) and tricuspid annulus tissue Doppler imaging (S ′) have been observed independently of clinical signs of RV failure. This has led to uncertainty of these variables’ validity in cardiac surgery. To describe transesophageal echocardiographic (TEE) measures of RV function during coronary artery bypass graft surg...
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research
Abstract Despite broad availability, extended hemodynamic monitoring is used in practice only in the minority of critical care patients. Pathophysiological reasoning suggests that systemic perfusion pressure (and thereby arterial as well as central venous pressure), cardiac stroke volume, and the systemic oxygen balance are key variables in maintaining adequate organ perfusion. In line with these assumptions, several studies support that a goal-directed optimization of these hemodynamic variables leads to a reduction in morbidity and mortality. The appropriate monitoring modality should be selected follo...
Source: Der Anaesthesist - Category: Anesthesiology Authors: Tags: Anaesthesist Source Type: research
CONCLUSIONS: Despite low bias, the wide limits of agreement of Doppler-derived CO by 3D TEE compared to CO by thermodilution will limit clinical application and can therefore not be considered interchangeable with CO obtained by thermodilution. The lack of agreement is not explained by lack of agreement of the 3D technique. PMID: 29324489 [PubMed - as supplied by publisher]
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
No one would deny the need for safe, reliable, and non-invasive cardiac output (CO) monitoring in anaesthesia and acute medicine. Measuring CO, or better still stroke volume (SV), adds a further dimension to haemodynamic monitoring as it completes the circulatory equation BP=CO×PR, where BP is blood pressure, PR is peripheral resistance, CO=SV×HR, and HR is heart rate. Clinical use of the pulmonary artery thermodilution catheter has been in decline since the 1990s,1 and newer, less invasive technologies have been developed that still need clinical evaluation.2 Since its first description in 1986, the Bland&ndas...
Source: British Journal of Anaesthesia - Category: Anesthesiology Source Type: research
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Source: Circulation - Category: Cardiology Authors: Tags: Circulation Source Type: research
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Source: Veterinary Anaesthesia and Analgesia - Category: Veterinary Research Authors: Tags: Research Paper Source Type: research
Conclusion and clinical relevanceFollowing IV co‐administration, MK‐467 effectively attenuated dexmedetomidine‐induced cardiovascular effects in cats. The drug combination resulted in transient reduction in arterial blood pressure, without causing hypotension.
Source: Veterinary Anaesthesia and Analgesia - Category: Veterinary Research Authors: Tags: Research Paper Source Type: research
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