J Clin Monit Comput - USCOM-window to the circulation: utility of supra-sternal Doppler in an elderly anaesthetized patient for a robotic cystectomy.

Tópicos

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Resumo

Supra-sternal Doppler (USCOM Ltd., Sydney, Australia) can be used during anaesthesia to measure cardiac output (CO) and related flow parameters. However, before the USCOM can be used routinely, its utility and limitations need to be fully understood and critical information about its use disseminated. In "Window to the Circulation" we use the example of an elderly man undergoing major urological robotic surgery to highlight the utility and limitations of intra-operative USCOM use. USCOM readings were verified against oesophageal Doppler. Despite the lack of major blood loss (<500 ml in 8-h), significant changes in haemodynamics were recorded. CO ranged from 3.2 to 8.3 l/min. The quality of USCOM scans and reliability of data was initially poor, but improved as CO increased as surgery progressed. When USCOM scans became acceptable the correlation with oesophageal Doppler was R(2) = 8.0 (p < 0.001). Several characteristic features of the supra-sternal Doppler scans were identified: Aortic and pulmonary flow waves, valve closure, E and A waves, false A-wave and aberrant arterial flow patterns. Their identification helped with identifying the main flow signal across the aortic valve. The USCOM has the potential to monitor changes in CO and related flow parameters intra-operatively and thus help the anaesthetist to more fully understand the patient's haemodynamics. However, achieving a good quality scan is important as it improves the reliability of USCOM data. The supra-sternal route is rich in flow signals and identifying the aortic valve signal is paramount. Recognizing the other characteristic waveforms in the signal helps greatly.

Resumo Limpo

suprastern doppler uscom ltd sydney australia can use anaesthesia measur cardiac output co relat flow paramet howev uscom can use routin util limit need fulli understood critic inform use dissemin window circul use exampl elder man undergo major urolog robot surgeri highlight util limit intraop uscom use uscom read verifi oesophag doppler despit lack major blood loss ml h signific chang haemodynam record co rang lmin qualiti uscom scan reliabl data initi poor improv co increas surgeri progress uscom scan becam accept correl oesophag doppler r p sever characterist featur suprastern doppler scan identifi aortic pulmonari flow wave valv closur e wave fals awav aberr arteri flow pattern identif help identifi main flow signal across aortic valv uscom potenti monitor chang co relat flow paramet intraop thus help anaesthetist fulli understand patient haemodynam howev achiev good qualiti scan import improv reliabl uscom data suprastern rout rich flow signal identifi aortic valv signal paramount recogn characterist waveform signal help great

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