A rapid method for transesophageal echocardiographic cardiac assessment

Monitoring during paediatric cardiac anaesthesia

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.

What's new in monitoring the coronary surgery patient?

Monitoring has been extensively reviewed in most textbooks of cardiothoracic surgery and anaesthesia, particularly in the recent textbooks on monitoring edited by Carol L Lake 1 and Casey D Blitt 2 and in the Journal of Clinical Monitoring. Although monitoring properly includes both pre- and postoperative periods, this review will concentrate exclusively on the operative period. I will also concentrate on new approaches or information which relate to more traditional approaches to monitoring. The emphasis in this review will not be on what we can monitor, but rather on what we should monitor. In this regard, I will analyse accuracy and identify sources of error and try to answer the following questions. Does the device or parameter measure (monitor) what we want to know? Does it improve patient outcome and safety? Is it cost-effective? Unfortunately, data are not always available to answer all these questions at present, but hopefully the discussions will make us aware of what we do and do not know, and what we should look for in the near future.