Monitoring in Anesthesia and Perioperative Care

437 Pages·2011·9.31 MB·English

by  David L. Reich MD

Monitoring in Anesthesia
and Perioperative Care
MonitoringinAnesthesiaandPerioperativeCareisapracticalandcomprehensiveresource
documentingthecurrentartandscienceofperioperativepatientmonitoring,addressingthe
systems-basedpracticeissuesthatdrivethehighlyregulatedhealthcareindustryoftheearly
21stcentury.
Initialchapterscoverthehistory,medicolegalimplications,validityofmeasurement,and
educationissuesrelatingtomonitoring.Thecoreofthebookaddressesthemanymonitoring
modalities,withthemajorityofthechaptersorganizedinasystematicfashiontodescribe
technicalconcepts,parametersmonitored,evidenceofutility,complications,credentialingand
monitoringstandards,andpracticeguidelines.
Describingeachdevice,technique,andprincipleofclinicalmonitoringinanaccessible
style,MonitoringinAnesthesiaandPerioperativeCareisfullofvaluableadvicefromtheleading
expertsinthefield,makingitanessentialtoolforeveryanesthesiologist.
DavidL.Reich,M.D.wasnamedProfessorandChairofAnesthesiologyattheMountSinaiSchoolof
MedicineinNewYorkin2004,wherehehadbeenCo-DirectorofCardiothoracicAnesthesiasince1990.
Dr.Reich’sresearchinterestsincludeneurocognitiveoutcomefollowingthoracicaorticsurgery,outcome
effectsofintraoperativehemodynamics,medicalinformatics,andhemodynamicmonitoring.Hehas
publishedmorethan90peer-reviewedarticlesandmorethan30bookchapters,andheisanassociate
editorofthetextCardiacAnesthesiaandeditor-in-chiefofSeminarsinCardiothoracicandVascular
Anesthesia.HeisamemberoftheInternationalOrganizationforTerminologyinAnesthesia(IOTA)of
theAnesthesiaPatientSafetyFoundationandworkswiththatgroup,theInternationalHealth
TerminologyStandardsDevelopmentOrganisation(IHTDSO),andHighLevelSevenInternational
(HL7)tocreateinternationalstandardsforanesthesiaterminologyforelectronicpatientrecords.
RonaldA.Kahn,M.D.isProfessorofAnesthesiologyandSurgeryattheMountSinaiSchoolofMedicine.
AlexanderJ.C.Mittnacht,M.D.isAssociateProfessorofAnesthesiologyattheMountSinaiSchoolof
MedicineandDirectorofPediatricCardiacAnesthesiaattheMountSinaiMedicalCenter.
AndrewB.Leibowitz,M.D.isProfessorofAnesthesiologyandSurgeryattheMountSinaiSchoolof
MedicineandExecutiveViceChairmanoftheDepartmentofAnesthesiologyattheMountSinaiMedical
Center.
MarcE.Stone,M.D.isAssociateProfessorofAnesthesiologyattheMountSinaiSchoolofMedicineand
ProgramDirectoroftheFellowshipinAdultCardiothoracicAnesthesiologyattheMountSinaiMedical
Center.
JamesB.Eisenkraft,M.D.isProfessorofAnesthesiologyattheMountSinaiSchoolofMedicineand
AttendingAnesthesiologistattheMountSinaiMedicalCenter.

Monitoring in Anesthesia
and Perioperative Care
Editor
DavidL.Reich
MountSinaiSchoolofMedicine
Coeditors
RonaldA.Kahn
MountSinaiSchoolofMedicine
AlexanderJ.C.Mittnacht
MountSinaiSchoolofMedicine
AndrewB.Leibowitz
MountSinaiSchoolofMedicine
MarcE.Stone
MountSinaiSchoolofMedicine
JamesB.Eisenkraft
MountSinaiSchoolofMedicine
CAMBRIDGEUNIVERSITYPRESS
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Informationonthistitle:www.cambridge.org/9780521755986
(cid:2)C CambridgeUniversityPress2011
Thispublicationisincopyright.Subjecttostatutoryexception
andtotheprovisionsofrelevantcollectivelicensingagreements,
noreproductionofanypartmaytakeplacewithoutthewritten
permissionofCambridgeUniversityPress.
Firstpublished2011
PrintedintheUnitedStatesofAmerica
AcatalogrecordforthispublicationisavailablefromtheBritishLibrary.
LibraryofCongressCataloginginPublicationdata
Monitoringinanesthesiaandperioperativecare/[editedby]DavidL.
Reich,RonaldA.Kahn,AlexanderJ.C.Mittnacht,AndrewB.
Leibowitz,MarcE.Stone,JamesB.Eisenkraft.
p.; cm.
Includesbibliographicalreferencesandindex.
ISBN978-0-521-75598-6(hardback)
1.Anesthesia. 2.Patientmonitoring. I.Reich,DavidL.
(DavidLouis),1960–,editor. II.Kahn,RonaldA.,editor.
III.Mittnacht,AlexanderJ.C.,editor. IV.Leibowitz,AndrewB.,
editor. V.Stone,MarcE.,editor. VI.Eisenkraft,JamesB.,editor.
[DNLM: 1.Monitoring,Intraoperative–methods. 2.Anesthesia–
methods. 3.PerioperativeCare–methods. WO181]
RD82.M68 2011
617.9(cid:3)6–dc22 2010045695
ISBN978-0-521-75598-6Hardback
CambridgeUniversityPresshasnoresponsibilityforthepersistenceor
accuracyofURLsforexternalorthird-partyInternetWebsites
referredtointhispublicationanddoesnotguaranteethatanycontent
onsuchWebsitesis,orwillremain,accurateorappropriate.
Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurate
andup-to-dateinformationthatisinaccordwithacceptedstandards
andpracticeatthetimeofpublication.Althoughcasehistoriesare
drawnfromactualcases,everyefforthasbeenmadetodisguisethe
identitiesoftheindividualsinvolved.Nevertheless,theauthors,
editors,andpublisherscanmakenowarrantiesthattheinformation
containedhereinistotallyfreefromerror,notleastbecauseclinical
standardsareconstantlychangingthroughresearchandregulation.
Theauthors,editors,andpublishersthereforedisclaimallliabilityfor
directorconsequentialdamagesresultingfromtheuseofmaterial
containedinthisbook.Readersarestronglyadvisedtopaycareful
attentiontoinformationprovidedbythemanufacturerofanydrugsor
equipmentthattheyplantouse.
Contents
Contributors vii
ForewordbyCarolL.Lake x
Preface xii
1 Thehistoryofanesthesiaandperioperative 15 Monitoringpressure,volume,andflowin
monitoring 1 theanesthesiabreathingsystem 171
DavidL.Reich JamesB.Eisenkraft
2 Medicolegalimplicationsofmonitoring 9 16 Pulseoximetry 185
JeffreyM.Feldman TuulaS.O.KurkiandJamesB.Eisenkraft
3 Validity,accuracy,andrepeatabilityof 17 Neurologicintraoperativeelectrophysiologic
monitoringvariables 16 monitoring 199
DanielM.ThysandJungKim MichaelL.McGarveyandAlbertT.Cheung
4 Teachingmonitoringskills 27 18 Levelofconsciousnessmonitoring 218
SamuelDeMaria,Jr.,AdamI.Levine, MarcJ.Bloom
andYasuharuOkuda
19 TranscranialDoppler 226
5 Electrocardiography 36 DeanB.Andropoulos
AlexanderJ.C.MittnachtandMartinLondon
20 Multimodalitymonitoringincriticallyill
6 Arterialpressuremonitoring 45 neurologicpatients 237
AlexanderJ.C.MittnachtandTuulaS.O.Kurki JenniferA.Frontera
7 Centralvenousandpulmonaryartery 21 Near-infraredspectroscopy 249
catheterization 57 DeanB.Andropoulos
DeborahDubenskyandAlexanderJ.C.Mittnacht
22 Perioperativemonitoringofneuromuscular
8 Cardiacoutputandintravascularvolume 79 function 261
MukulKapoorandMarcE.Stone AaronF.Kopman
9 Gastrictonometry 95 23 Criticalcaretestingintheoperatingroom:
ElliottBennett-Guerrero electrolytes,glucose,acid–base,bloodgases 281
LakshmiV.Ramanathan,JuditTolnai,and
10 Oxygendelivery,oxygentransport,andtissue
MichaelS.Lewis
oxygentension:criticalmonitoringintheICU 98
JayashreeRaikhelkarandPeterJ.Papadakos 24 Laboratory-basedtestsofbloodclotting 291
NathaenWeitzel,TamasSeres,andGlennP.Gravlee
11 Transesophagealechocardiography 105
RonaldA.KahnandGregoryW.Fischer 25 Coagulationandhematologicpoint-of-care
testing 308
12 Ultrasoundguidanceofvascularcatheterization 136
LizaJ.EnriquezandLindaShore-Lesserson
AndrewB.LeibowitzandJonathanElmer
26 Cardiacbiomarkersforperioperative
13 Ultrasoundguidanceforregionalanesthesia
management 319
procedures 145
AnoushkaAfonsoandEricAdler
ChristinaL.JengandMegA.Rosenblatt
27 Endocrinetestingintheoperatingroom 327
14 Respiratorygasmonitoring 150
LakshmiV.RamanathanandMichaelS.Lewis
JamesB.Eisenkraft
v
Contents
28 Temperaturemonitoring 331 34 Intensivecareunitriskscoring 369
DavidWaxandJustinLipper AdelBassily-MarcusandRoopaKohli-Seth
29 Fetalheartratemonitoring 337 35 Computersandmonitoring:information
HowardH.Bernstein managementsystems,alarms,anddrug
delivery 383
30 Painscales 348
DavidWaxandMatthewLevin
JonathanEpstein,DianaMungall,andYaakovBeilin
31 Neurologicclinicalscales 353
JenniferA.Frontera Appendix:Monitoringrecommendationsfor
commontypesofsurgicalprocedures 397
32 Postanesthesiacareunitassessmentscales 357
Index 405
DavidBronheimandRichardS.Gist
33 Deliriummonitoring:scalesandassessments 360 Colorplatesfollowpage260.
BrigidFlynnandCoreyScurlock
vi
Contributors
EricAdler,M.D. MarcJ.Bloom,M.D.,Ph.D.
AssistantProfessor AssociateProfessorofAnesthesiology
DepartmentofCardiology NewYorkUniversitySchoolofMedicine
MountSinaiSchoolofMedicine NewYork,NY
NewYork,NY
DavidBronheim,M.D.
AnoushkaAfonso,M.D. AssociateProfessor
AnesthesiaResident DepartmentofAnesthesiology
DepartmentofAnesthesiology MountSinaiSchoolofMedicine
MountSinaiSchoolofMedicine NewYork,NY
NewYork,NY
AlbertT.Cheung,M.D.
DeanB.Andropoulos,M.D.,M.H.C.M. Professor
ChiefofAnesthesiology DepartmentofAnesthesiologyandCritical
TexasChildren’sHospital Care
Professor,AnesthesiologyandPediatrics UniversityofPennsylvaniaSchoolofMedicine
BaylorCollegeofMedicine Philadelphia,PA
Houston,TX
SamuelDeMaria,Jr.,M.D.
AdelBassily-Marcus,M.D. InstructorinAnesthesiology
AssistantProfessor DepartmentofAnesthesiology
DepartmentofSurgery MountSinaiSchoolofMedicine
DivisionofCriticalCareMedicine NewYork,NY
MountSinaiSchoolofMedicine DeborahDubensky,M.D.
NewYork,NY
DepartmentofAnesthesiology
UniversityofRochesterMedicalCenter
YaakovBeilin,M.D.
Rochester,NY
Professor
DepartmentofAnesthesiology JamesB.Eisenkraft,M.D.
DepartmentofObstetrics,Gynecology,andReproductive Professor
Science DepartmentofAnesthesiology
MountSinaiSchoolofMedicine MountSinaiSchoolofMedicine
NewYork,NY NewYork,NY
ElliottBennett-Guerrero,M.D. JonathanElmer,M.D.
ProfessorandDirectorofPerioperativeClinicalResearch ClinicalFellow
DukeClinicalResearchInstitute DepartmentofEmergencyMedicine
DukeUniversityMedicalCenter BrighamandWomen’sHospital
Durham,NC Boston,MA
HowardH.Bernstein,M.D. LizaJ.Enriquez,M.D.
AssociateProfessor Fellow
DepartmentofAnesthesiology DepartmentofAnesthesiology
MountSinaiSchoolofMedicine MontefioreMedicalCenter
NewYork,NY Bronx,NY
vii
Contributors
JonathanEpstein,M.D.,M.A. JennyKam,M.D.
AttendingAnesthesiologist ChiefResident
St.Luke’s–RooseveltHospitalCenter DepartmentofAnesthesiology
NewYork,NY
MukulKapoor,M.D.
JeffreyM.Feldman,M.D.,M.S.E. SeniorAdviser
AssociateProfessorofClinicalAnesthesiology AnaethesiologyandCardiothoracicAnaesthesiology
DepartmentofAnesthesiologyandCriticalCare CommandHospital
Medicine Lucknkow,India
UniversityofPennsylvaniaSchoolofMedicine
JungKim,M.D.
DivisionChief,GeneralAnesthesia
DepartmentofAnesthesiology
Children’sHospitalofPhiladelphia
St.Luke’s–RooseveltHospitalCenter
Philadelphia,PA
NewYork,NY
GregoryW.Fischer,M.D.
RoopaKohli-Seth,M.D.
AssociateProfessorofAnesthesiologyandCardiothoracic
AssistantProfessor
Surgery
DepartmentofSurgery
DirectorofAdultCardiothoracicAnesthesia
DivisionofCriticalCareMedicine
MountSinaiSchoolofMedicine
MountSinaiSchoolofMedicine
NewYork,NY
NewYork,NY
BrigidFlynn,M.D.
AaronF.Kopman,M.D.
AssistantProfessor
ProfessorofClinicalAnesthesiology
DepartmentofAnesthesiology
WeillCornellMedicalCollege
MountSinaiSchoolofMedicine
NewYork,NY
NewYork,NY
TuulaS.O.Kurki,M.D.,Ph.D.
JenniferA.Frontera,M.D. HeadofthePreoperativeClinic
AssistantProfessor DepartmentofAnesthesiaandIntensiveCare
DepartmentsofNeurologyandNeurosurgery HelsinkiUniversityCentralHospital
MountSinaiSchoolofMedicine Helsinki,Finland
NewYork,NY
AndrewB.Leibowitz,M.D.
RichardS.Gist,M.D. ProfessorofAnesthesiologyandSurgery
Professor DepartmentofAnesthesiology
DepartmentofAnesthesiology MountSinaiSchoolofMedicine
MountSinaiSchoolofMedicine NewYork,NY
NewYork,NY
MatthewLevin,M.D.
GlennP.Gravlee,M.D. MountSinaiSchoolofMedicine
Professor NewYork,NY
DepartmentofAnesthesiology
AdamI.Levine,M.D.
UniversityofColoradoDenver
AssociateProfessor
Aurora,CO
DepartmentofAnesthesiology
ChristinaL.Jeng,M.D. MountSinaiSchoolofMedicine
AssistantProfessorofAnesthesiologyandOrthopaedics NewYork,NY
DepartmentofAnesthesiology
MichaelS.Lewis,M.D.
MountSinaiSchoolofMedicine
DirectorofTransfusionMedicineandHistology
NewYork,NY
AssistantProfessorofPathology
RonaldA.Kahn,M.D. UniversityofSouthernCalifornia,KeckSchoolofMedicine
ProfessorofAnesthesiology AttendingPathologist
DepartmentofAnesthesiology WestLosAngelesVAHospital
MountSinaiSchoolofMedicine MountSinaiSchoolofMedicine
NewYork,NY LosAngeles,CA
viii
Contributors
JustinLipper,M.D. DepartmentofAnesthesiology
MountSinaiSchoolofMedicine MountSinaiSchoolofMedicine
NewYork,NY NewYork,NY
MartinLondon,M.D. MegA.Rosenblatt,M.D.
ProfessorofClinicalAnesthesia Professor
UniversityofCalifornia,SanFrancisco DepartmentofAnesthesiology
SanFrancisco,CA MountSinaiSchoolofMedicine
NewYork,NY
MichaelL.McGarvey,M.D.
AssistantProfessor
CoreyScurlock
DepartmentofNeurology
AssistantProfessor
UniversityofPennsylvania
DepartmentsofAnesthesiologyandCardiothoracic
Philadelphia,PA
Surgery
AlexanderJ.C.Mittnacht,M.D. MountSinaiSchoolofMedicine
AssociateProfessor NewYork,NY
DepartmentofAnesthesiology
MountSinaiSchoolofMedicine TamasSeres,Ph.D.
NewYork,NY AssociateProfessor
DepartmentofAnesthesiology
TimothyMooney,MD
UniversityofColoradoDenver
Fellow
Aurora,CO
DukeUniversityMedicalCenter
Durham,NC LindaShore-Lesserson,M.D.
ProfessorofAnesthesiology
DianaMungall,B.S.
MontefioreMedicalCenter
DepartmentofAnesthesiology
Bronx,NY
MountSinaiSchoolofMedicine
NewYork,NY
MarcE.Stone,M.D.
YasuharuOkuda,M.D. AssociateProfessor
AssociateClinicalProfessor DepartmentofAnesthesiology
DepartmentofEmergencyMedicine MountSinaiSchoolofMedicine
MountSinaiSchoolofMedicine NewYork,NY
NewYork,NY
DanielM.Thys,M.D.
PeterJ.Papadakos,M.D.,F.C.C.M.
ChairmanEmeritus
ProfessorofAnesthesiology,Surgery,andNeurosurgery
DepartmentofAnesthesiology
Director,DivisionofCriticalCareMedicine
St.Luke’s–RooseveltHospitalCenter
UniversityofRochester
NewYork,NY
Rochester,NY
JayashreeRaikhelkar,M.D. JuditTolnai,B.S.
AssistantProfessor DepartmentofPathology
DepartmentsofAnesthesiologyandCardiothoracicSurgery MountSinaiSchoolofMedicine
MountSinaiSchoolofMedicine NewYork,NY
NewYork,NY
DavidWax,M.D.
LakshmiV.Ramanathan,Ph.D.
AssistantProfessor
AssistantProfessor
DepartmentofAnesthesiology
DepartmentofPathology
MountSinaiSchoolofMedicine
MountSinaiSchoolofMedicine
NewYork,NY
Director,Chemistry,Endocrinology,StatLab,andPointof
CareTesting NathaenWeitzel,M.D.
MountSinaiMedicalCenter
AssistantProfessor
NewYork,NY
DepartmentofAnesthesiology
DavidL.Reich,M.D. UniversityofColoradoDenver
ProfessorandChairofAnesthesiology Aurora,CO
ix