Co-existing Diseases and Neuroanesthesia by Hemanshu Prabhakar & Vasudha Singhal & Nidhi Gupta

Author:Hemanshu Prabhakar & Vasudha Singhal & Nidhi Gupta
Language: eng
Format: epub
ISBN: 9789811320866
Publisher: Springer Singapore

7.9.6 Intraoperative Monitoring

In addition to the usual intraoperative monitors, hemodynamically unstable ESRD patients may require pre-anesthesia placement of arterial line to provide the real-time blood pressure and CO monitoring. Central venous access may be required for administering vasopressors or inotropes and central venous oxygen saturation (ScvO2) monitoring. In general, invasive venous or arterial access is often challenging in view of numerous previous surgeries, pre-existing fistulae, failed cannulation attempts, hematoma, venous collapse after HD, thrombotic vessel occlusion, or the effects of residual anticoagulation. Use of ultrasound imaging to guide central venous catheter insertion has been recommended. Intraoperative NM monitoring reduces the risk of prolonged NM blockade and residual paralysis. Use of point-of-care tests, including thromboelastography, may improve perioperative coagulation management in patients with ESRD. Special attention is required during patient positioning. Arms with vascular accesses should be kept free from blood pressure cuffs, pulse oximeters, tourniquets, and peripheral venous cannulae. In addition, presence of preoperative neuropathy mandates proper documentation and extra caution during patient positioning.

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