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16

Mar

2020

Modern Monitoring in Anesthesiology and Perioperative Care

 

@daanstevens, Unsplash

 

Modern Monitoring in Anesthesiology and Perioperative Care is essentially a manual to help health care providers navigate their way through a seemingly endless array of monitoring devices that promise higher quality care, better outcomes, easy installation, and rapid adoption. The fact is that we have mostly monitored heart rate, blood pressure, respiratory rate, and oxygen saturation as our core vital signs, and in the same way, for the past 35 years. In fact, since the routine use of pulse oximetry in the mid 1980’s not much has changed at all. A few years prior to the introduction of pulse oximetry, pulmonary artery catheters became the panacea, even recommended for all patients over the age of 60 years old undergoing relatively routine operations like colon resection, despite their invasiveness. At one time, pulmonary artery catheters were nearly synonymous with critical care, and I personally had many days when I inserted four or more. While these devices went from invention to widespread use in less than 10 years, it took two decades for proof of inefficacy and potential harm until they were finally mostly abandoned except for use in very select cases. This left a vacuum for providers yearning for a useful measure of circulatory variables to guide patient care.

Over the last decade there has been an explosion of devices that can be used to monitor the brain, heart, and lungs, as well as devices to predict fluid responsiveness.  Point-of-care ultrasound has advanced almost to the point of replacing the stethoscope. In just the last 5 years anyone can buy wearable, wireless, cloud-based, AI/“big data”-based monitors. It is impossible to predict which of these monitors will have the staying power of the pulse oximeter with its virtues of being cheap, easy to use, readily understandable, and providing continuous actionable data, versus which will have a fate similar to the pulmonary artery catheter, taking 30 years to discover its limitations before being forgotten. That is where this book fits in. The goal is to give the average clinician insight into why a certain variable should be monitored, how the device works, and what is the evidence that its use improves outcomes. It also provides readers with a framework to vet any new device, including statistical methods to assess monitor efficacy and the role of digital distraction.

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About the Author: Suzan Uysal

Suzan Uysal is an Associate Professor of Anesthesiology, Perioperative and Pain Medicine at the Icahn School of Medicine at Mount Sinai....

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About the Author: Andrew B. Leibowitz

Andrew B. Leibowitz is the Professor and System Chair for Anesthesiology, Perioperative and Pain Medicine at the Icahn School of Medicine at Mount Sinai....

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