Today I basically had a single case - a 3-vessel Coronary Artery Bypass Graft (CABG). The monitoring in this case was pretty intense. First, we had the basic monitors that everybody under general anesthesia has:
pulse oxymeter - heart rate and oxygen saturation
ECG - for showing a continuous electrocardiogram, monitoring for cardiac ischemia, etc (oh, he came in with ST-depression, evidence of ischemia)
non-invasic blood pressure cuff - for blood pressure (duh)
Ventilatory monitors - to show us air flow, pressures End-titdal CO2, FiO2, inspired oxygen concentration, inspired anesthetic gas concentrations
Temperature probe - for looking at "shell temperature"
And since this case was a bit involved, we also had:
Arterial line - continuous blood pressure monitoring (when every 3-minutes is just not sufficient)
Central venous line with a pulmonary artery catheter - pulmonary pressures, core temperature, measurement of cardiac output and cardiac index, and right ventricular end-diastolic pressure
Transesophageal Echocardiography (TEE) with doppler - this uses an echocardiograph machine similar to what is used in regular echo, but the probe is placed in the esophagus rather than on the front of the chest. Amazing pictures, nice view of the heart valves, and we were able to see and estimate (using color dopler) the direction of blood flow and detect some blood regurgitation from a bad valve. This site shows some of what we could see.
And then there were the monitors on the bypass machine, which I mostly ignored and let the perfusionist worry about.
It was also pretty freaky to see the cardioplegia - I could look into the hole in his chest and see a non-beating heart, the ECG was flat (i.e.-"flatlining"), and his pulmonary artery pressure was zero (i.e.-no flow through the lungs). Yikes! And yes, he was brought back to life near the end.
Posted by calv0016 at September 28, 2005 04:23 PM