ISSN:0039-6206    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0039-6206    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0039-6206    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0039-6206    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0039-6206    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0039-6206    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0039-6206    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0039-6206    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

One of the primary roles of the anesthesiologist is that of decision maker. This individual is responsible for acquiring and interpreting information regarding the state of the anesthesia delivery system (patient and equipment), comparing the current status of the system to a desired condition, and either taking an appropriate action or making a decision for a potential corrective action which will produce a shift toward a desirable state. The role of monitoring in anesthesia is to provide the anesthesiologist with the necessary decision-making information accurately and reliably.In addition to helping direct the anesthetic toward the desired state, appropriately designed and implemented monitoring systems may directly reduce the incidence of human error and identify equipment-related problems. As numerous studies indicate, patients undergoing anesthesia and surgery are at appreciable risk. However, increasing the risk because of human error, equipment/anesthesiologist interactions, and equipment hazards is unacceptable.Today approximately 50 variables can be measured simultaneously on every patient, and an additional 25 calculated. Continuously assimilating this amount of data is an overwhelming task. Some means of reducing the number of variables constantly being interpreted is needed, but selection of essential variables for decision making and vigilance monitoring is difficult without sufficient data. To compound the problem, recent advances in technology are producing an ever increasing number of new developments in instrumentation. We continually find ourselves in a “Catch 22.” The catch is that there are not enough data to justify utilization of this new equipment, but these data cannot be obtained until the new equipment is implemented into clinical care. Therefore, this technological explosion has left us in a dilemma of variable selection.With the increased emphasis on risk/benefit and cost/benefit ratios, the traditional patient monitors of ECG, heart rate, blood pressure, temperature, and stethoscope are not sufficient. Reviews of the current liability problem indicate that events that produce catastrophic results frequently occur because of loss of oxygen supply to the brain. Hence, this implies that, in the very least, anesthesiologists need to monitor oxygen supply, exchange, and end organ function, especially the brain. This further implies that equipment or patient variables that indicate changes in this oxygen supply chain must be monitored in such a way that untoward events are detected early enough that appropriate corrective intervention can occur.Currently, oxygen supply is routinely monitored by supply pressure, flow via rotameter, and concentration in the patient breathing circuit with oxygen analyzers. Fortunately, the trend toward assessing oxygen exchange with either transcutaneous oxygen monitoring or pulse oximetry is beginning.Although sensitive and specific monitors for disruptions in oxygen supply produced by events such as breathing circuit disconnects and esophageal intubations are readily available, they are not being widely used. Monitoring the concentrations of all gas constituents in the patient breathing circuit, patient airway pressures, and tidal volumes (inspired and expired) not only detects airway disconnects and esophageal intubations, but also provides additional quantitative information about delivery equipment performance and patient response.Monitoring end organ function, especially the brain, is more difficult. Today's processed EEC technology presents more questions than answers. However, the trend toward development and utilization of technology for nervous system monitoring is well recognized.Advances in anesthesia monitoring will continue to be accomplished by applying new technologies to the measurement of various physiologic phenomena. Unfortunately, the anesthetist is now faced with an overabundance of data as well as the task of locating these new devices in convenient places. It is time to apply other technologies, ergonomics, and human factors to automate and integrate instrument application. Monitoring systems must fit naturally with the way the anesthetist delivers anesthesia. If these principles are not applied, new monitors will become aggravations due to the inconvenience, distraction, and increased manual and mental tasks associated with their use.Current trends toward physical integration and functional integration, and use of computers should continue with emphasis on the problems

ISSN:0039-6206    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0039-6206    

出版商:OVID    

年代:1987

数据来源: OVID