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P A T I E N T
M O N I T O R I N G
WAVE OF THE FUTURE
Will Monitoring Become More Invasive?
O
nce you move beyond EKG, blood pressure, pulse ox, and the like, monitors
abruptly transition from topical to invasive. Currently, the market is giving rise to
devices that provide transcutaneous versions of formerly invasive monitoring,
such as blood pH and hemoglobin analysis to assess cardiac output, says Carl R. Noback,
MD, a board-certified anesthesiologist with a subspecialty in pain management and the
medical director for Innovative Practice Strategies in Sarasota,
Fla.
"Generally speaking, I think we're going to see more of a
need to use some of these higher-level noninvasive monitors as
more of the bigger cases —multi-level spinal fusions, joint
replacements — move to the outpatient setting," he says.
Dr. Noback also sees a trend toward the use of invasive monitoring, such as central venous pressure monitoring, in the outpa-
BEYOND THE BASICS
Tracking standard vital
signs may not be adequate as more complex
cases move to the outpatient arena.
tient setting. "A lot of managers and administrators might say, 'I don't want to go to that
expense. We operate only on ASA 1 or 2 patients, maybe the occasional ASA 3 in this
facility,'" he says. "But ASA physical status is a pre-procedure assessment of the patient
and doesn't take into account physiologic changes that happen during procedures."
For example, if a surgeon nicks an epidural vein, a patient's ASA status won't have
much bearing; rather, the right monitor could spot blood loss more quickly. As more complex, traditionally inpatient procedures shift to outpatient facilities, and anesthetic monitoring practice changes accordingly, Dr. Noback believes more recommendations and
regulations will call for equivalent monitoring to prevent and manage physiologic disruption caused by unintended events during procedures.
— Stephanie Wasek
(capnography), exhaled gas analysis, body temperature and pulse oximetry. Pulse
ox monitors delivery and global function of the respiratory system and, coupled
with BP and EKG, establishes a solid set of vital signs to monitor.
Bispectral index (BIS) monitoring of depth of consciousness is optional, and it
has its proponents, but it comes with a non-reimbursable per-utilization cost
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SUPPLEMENT
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O U T PAT I E N T S U R G E R Y M A G A Z I N E | J U LY 2013
