Anesthesia in Thoracic Surgery Changes of Paradigms

Toraman F.

Springer-Verlag , Zürich, 2020

  • Publication Type: Book / Vocational Book
  • Publication Date: 2020
  • Publisher: Springer-Verlag
  • City: Zürich


Changes in Classical Monitoring: Hemodynamic Monitoring, New Devices, NIRS, etc. Alberto Hernandez, Fevzi Toraman, and Aslı Demir 18.1 Hemodynamic Monitoring In perioperative medicine, hemodynamic management aims at an optimization of perfusion pressure and oxygen delivery (DO2) in order to maintain or restore adequate cellular metabolism. For complex patients in the operating room or in the intensive care unit, many questions regarding their hemodynamic management cannot be answered with simple clinical examination. In particular, arterial pressure allows only a rough estimation of CO. Until recently, the measurement of advanced hemodynamic variables required invasive hemodynamic monitoring. Advanced cardiovascular monitoring typically consists of invasive blood pressure and central venous pressure (CVP), CO monitoring, and other parameters such as central venous or mixed oxygen saturation (SvcO2/SvO2) will provide very valuable information for the management of the hemodynamically unstable patients, as it will be able to influence the different variables that influence the DO2 to the tissues (see Fig. 18.1). Hemodynamic monitoring represents a functional tool that may be used to derive estimates of performance and physiological reserve that may in turn direct treatment. Many methods have been developed to carry out advanced cardiovascular monitoring, some invasive, others semi-invasive and even recently non-invasive (see Table 18.1). They have in common, that allow us to obtain data of the hemodynamics very reliable to be able to carry out a good handling of the patients