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P A T I E N T
M O N I T O R I N G
capnography followed the availability
Today's warming devices try to cover
of early mass spectrometers and was
as much of the body as possible to
concomitant with the rise of infrared
transfer maximum heat, and subse-
CO2 analyzers," he says.
quently get patients to discharge criteria faster in recovery (see "Warming
Capnography has 2 key uses intraoperatively. First, through identifica-
to Faster Patient Discharges" on page
tion of expired CO2, it ensures the
2).
endo tube has been properly placed
— that esophageal intubation (which
Avoiding trouble
can lead to adverse effects) hasn't
If a muscle relaxant is used, anesthe-
occurred. Second, it prevents hyper-
sia providers should employ neuro-
ventilation (which can change cere-
muscular monitoring to ensure ade-
bral blood flow and reduce anesthetic
quate oxygen delivery and ventilation,
flow) or hypercapnia (which is a
says Dr. Noback. It can be one of the
vasodilator and can create significant
first intraoperative indicators that a
problems with anesthesia manage-
patient is having respiratory difficul-
ment and recovery). End tidal moni-
ties and, post-operatively, lets you
toring lets the anesthesia provider
assess residual muscle relaxant effect.
"As the patient begins to wake,
play the role of Goldilocks, getting
everything "just right" by maintaining
metabolism and blood flow increase
a near-normal CO2 level, which indi-
again. This reperfusion of the blood
cates accuracy of respiration and
vessels can actually wash any residual
avoids over- or under-ventilation.
anesthetic agents into the system,
Temperature monitoring now stress-
renarcotizing the patient and poten-
es the importance of maintaining nor-
tially leading to respiratory distress,"
mothermia as nearly as possible. Not
he says. "Neuromuscular monitoring
just to track the temperature, but so
is especially crucial in overweight,
the OR staff can do something about it
obese and sleep apneatic patients,
by actively warming patients in whom
who are more vulnerable to such dis-
core temperatures have dipped.
tress in the first place."
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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
