Question

Case Study 1

Ella is an 18-month-old female who is scheduled for a bilateral myringotomy with PE tube placement for recurrent otitis media. She is in general good health and shows no signs of current illness or infection. Her preoperative vital signs were within normal range. She was given liquid midazolam preoperatively and arrives to the OR awake and alert but calm. The anesthesiologist plans to do masked ventilation for the procedure since it is of short duration.

Case Study 2

Ameera is a 28-year-old female who is scheduled for a cystoscopy with a ureteral stent exchange. She has a history of kidney stones. She is scheduled to have MAC anesthesia (local with sedation). She is in general good health and has no signs of current illness or infection. She is nervous about the procedure and concerned that she will experience pain.

Case Study 3

Icharo is a 45-year-old male who is scheduled for a left shoulder arthroscopy with a rotator cuff repair under a general anesthetic. He is in general good health but has a history of asthma.

Case Study 4

William is a 67-year-old male who is scheduled for an open coronary artery bypass graft. He has a history of hypertension, coronary artery disease, COPD, prostate cancer (treated 3 years ago by open prostatectomy, subsequent PSA is zero) and non-insulin dependent type II diabetes mellitus. His oxygen levels are 92%, his blood pressure is 150/95 mmHg and he reports that his fasting blood sugar levels tend to be around 140. He does not have any current acute illness or infection besides his cardiac condition. He arrived in the emergency department complaining of chest pain and pressure.

Based on the above case studies, determine what types of monitoring would be appropriate given the patient information for each of the case studies.

For each of the four case studies:

• Identify what type of monitoring needs to be done.
• Explain what the monitoring is measuring (ex: pulse oximeter, a non-invasive sensor applied to finger, toe or earlobe to measure percentage of saturation of peripheral oxygen. 95% or higher is ideal).

Answer 1

Questions and answers given below as per case study

Case Study 1

Ella is an 18-month-old female who is scheduled for a bilateral myringotomy with PE tube placement for recurrent otitis media. She is in general good health and shows no signs of current illness or infection. Her preoperative vital signs were within normal range. She was given liquid midazolam preoperatively and arrives to the OR awake and alert but calm. The anesthesiologist plans to do masked ventilation for the procedure since it is of short duration.

1. Identify what type of monitoring needs to be done.

1. Pulse Oximeter,

2. An Electrocardiogram (Ekg, Ecg)

3. A Temperature Probe.

4. Oxygen Analyzer And Carbon Dioxide Analyzer

5. Urinary Catheter

6. Transesophageal Echocardiograph.

7. Noninvasive Blood Pressure Monitors

8. Intravascular Pressure Measurements.

9. Capnography

10. Electroencephalogram

11.otoscope

2. Explain what the monitoring is measuring

1.A pulse oximeter: a small instrument that is attached to your finger, toe, or earlobe to measure the level of oxygen in your blood.

2.An electrocardiogram (EKG, ECG): to monitor your heart activity. Small wires (leads) are placed on the skin of your chest and held in place by small adhesive patches.

3.A temperature probe: A monitor connected to your skin by a lead held in place by a small round adhesive patch may be used to measure skin temperature. A thermometer that is attached to a small tube inserted through the mouth into the esophagus after you are unconscious may be used to measure internal body temperature.

4.An oxygen analyzer and carbon dioxide analyzer on the anesthesia machine: These instruments measure the amount of oxygen and carbon dioxide gases inhaled and exhaled in your breath.

5.A urinary catheter.:This is a small, flexible tube inserted into the bladder to collect urine.

6.A transesophageal echocardiograph.:This instrument is inserted through the mouth and down the throat into the esophagus to monitor the heart.

7.Non-invasive methods for measuring blood pressure (BP) are not adequate for monitoring hemodynamic parameters during a cardiac surgical procedure, especially one that involves CPB. Because of the following limitations, they often are used merely as adjuncts to invasive BP monitoring.

8.Intravascular pressure measurements. In cardiac anesthesia, it is very common to measure pressures within blood vessels directly. Arterial pressure often is measured by placing a catheter in a peripheral artery, while other catheters are placed within the central circulation to measure the central venous or intracardiac pressures. The components of a system of intravascular pressure measurement are the intravascular catheter, fluid-filled connector tubing, a transducer, and an electronic analyzer and display system.

9.Capnography
End-tidal capnography offers evidence of endotracheal intubation on an immediate, noninvasive basis and now is considered to be part of the minimum standard of anesthetic care. It also provides continuous monitoring of the expired CO₂.

10.Electroencephalogram . The electroencephalogram (EEG) measures the electrical currents generated by the postsynaptic potentials in the pyramidal cell layer of the cerebral cortex. The basic principle of clinical EEG monitoring is that cerebral ischemia causes slowing of the electrical activity of the brain, as well as a decrease in signal amplitude. An experienced electroencephalographer can interpret raw EEG data from four or eight channels, but would be hard pressed to also administer an anesthetic and monitor other organ systems.

11.Otoscope:to visualize inner ear

Case Study 2

Ameera is a 28-year-old female who is scheduled for a cystoscopy with a ureteral stent exchange. She has a history of kidney stones. She is scheduled to have MAC anesthesia (local with sedation). She is in general good health and has no signs of current illness or infection. She is nervous about the procedure and concerned that she will experience pain.

1. Identify what type of monitoring needs to be done.

1.A cystoscope

2. An Electrocardiogram (Ekg, Ecg)

3. A Temperature Probe.

4. Oxygen Analyzer And Carbon Dioxide Analyzer

5. Urinary Catheter

6. Transesophageal Echocardiograph.

7. Noninvasive Blood Pressure Monitors

8. Intravascular Pressure Measurements.

9. Capnography

10. Electroencephalogram

11.Pulse Oximeter,

2. Explain what the monitoring is measuring

1.A cystoscope to look inside the urethra and bladder. A cystoscope is a long, thin optical instrument with an eyepiece at one end, a rigid or flexible tube in the middle, and a tiny lens and light at the other end of the tube.

2.An electrocardiogram (EKG, ECG): to monitor your heart activity. Small wires (leads) are placed on the skin of your chest and held in place by small adhesive patches.

3.A temperature probe: A monitor connected to your skin by a lead held in place by a small round adhesive patch may be used to measure skin temperature. A thermometer that is attached to a small tube inserted through the mouth into the esophagus after you are unconscious may be used to measure internal body temperature.

4.An oxygen analyzer and carbon dioxide analyzer on the anesthesia machine: These instruments measure the amount of oxygen and carbon dioxide gases inhaled and exhaled in your breath.

5.A urinary catheter.:This is a small, flexible tube inserted into the bladder to collect urine.

6.A transesophageal echocardiograph.:This instrument is inserted through the mouth and down the throat into the esophagus to monitor the heart.

7.Non-invasive methods for measuring blood pressure (BP) are not adequate for monitoring hemodynamic parameters during a cardiac surgical procedure, especially one that involves CPB. Because of the following limitations, they often are used merely as adjuncts to invasive BP monitoring.

8.Intravascular pressure measurements. In cardiac anesthesia, it is very common to measure pressures within blood vessels directly. Arterial pressure often is measured by placing a catheter in a peripheral artery, while other catheters are placed within the central circulation to measure the central venous or intracardiac pressures. The components of a system of intravascular pressure measurement are the intravascular catheter, fluid-filled connector tubing, a transducer, and an electronic analyzer and display system.

9.Capnography
End-tidal capnography offers evidence of endotracheal intubation on an immediate, noninvasive basis and now is considered to be part of the minimum standard of anesthetic care. It also provides continuous monitoring of the expired CO₂.

10.Electroencephalogram . The electroencephalogram (EEG) measures the electrical currents generated by the postsynaptic potentials in the pyramidal cell layer of the cerebral cortex. The basic principle of clinical EEG monitoring is that cerebral ischemia causes slowing of the electrical activity of the brain, as well as a decrease in signal amplitude. An experienced electroencephalographer can interpret raw EEG data from four or eight channels, but would be hard pressed to also administer an anesthetic and monitor other organ systems.

11.A pulse oximeter: a small instrument that is attached to your finger, toe, or earlobe to measure the level of oxygen in your blood.

Case Study 3

Icharo is a 45-year-old male who is scheduled for a left shoulder arthroscopy with a rotator cuff repair under a general anesthetic. He is in general good health but has a history of asthma.

1. Identify what type of monitoring needs to be done.

1.Arthroscope Pulse Oximeter,

2. An Electrocardiogram (Ekg, Ecg)

3. A Temperature Probe.

4. Oxygen Analyzer And Carbon Dioxide Analyzer

5. Urinary Catheter

6. Transesophageal Echocardiograph.

7. Noninvasive Blood Pressure Monitors

8. Intravascular Pressure Measurements.

9. Capnography

10. Electroencephalogram

11.Pulse Oximeter,

2. Explain what the monitoring is measuring

1.Arthroscope is a narrow tube attached to a fiber-optic video camerais inserted through a small incision — about the size of a buttonhole. The view inside joint is transmitted to a high-definition video monitor.

2.An electrocardiogram (EKG, ECG): to monitor your heart activity. Small wires (leads) are placed on the skin of your chest and held in place by small adhesive patches.

3.A temperature probe: A monitor connected to your skin by a lead held in place by a small round adhesive patch may be used to measure skin temperature. A thermometer that is attached to a small tube inserted through the mouth into the esophagus after you are unconscious may be used to measure internal body temperature.

4.An oxygen analyzer and carbon dioxide analyzer on the anesthesia machine: These instruments measure the amount of oxygen and carbon dioxide gases inhaled and exhaled in your breath.

5.A urinary catheter.:This is a small, flexible tube inserted into the bladder to collect urine.

6.A transesophageal echocardiograph.:This instrument is inserted through the mouth and down the throat into the esophagus to monitor the heart.

7.Non-invasive methods for measuring blood pressure (BP) are not adequate for monitoring hemodynamic parameters during a cardiac surgical procedure, especially one that involves CPB. Because of the following limitations, they often are used merely as adjuncts to invasive BP monitoring.

8.Intravascular pressure measurements. In cardiac anesthesia, it is very common to measure pressures within blood vessels directly. Arterial pressure often is measured by placing a catheter in a peripheral artery, while other catheters are placed within the central circulation to measure the central venous or intracardiac pressures. The components of a system of intravascular pressure measurement are the intravascular catheter, fluid-filled connector tubing, a transducer, and an electronic analyzer and display system.

9.Capnography
End-tidal capnography offers evidence of endotracheal intubation on an immediate, noninvasive basis and now is considered to be part of the minimum standard of anesthetic care. It also provides continuous monitoring of the expired CO₂.

10.Electroencephalogram . The electroencephalogram (EEG) measures the electrical currents generated by the postsynaptic potentials in the pyramidal cell layer of the cerebral cortex. The basic principle of clinical EEG monitoring is that cerebral ischemia causes slowing of the electrical activity of the brain, as well as a decrease in signal amplitude. An experienced electroencephalographer can interpret raw EEG data from four or eight channels, but would be hard pressed to also administer an anesthetic and monitor other organ systems.

11.A pulse oximeter: a small instrument that is attached to your finger, toe, or earlobe to measure the level of oxygen in the blood.

Case Study 4

William is a 67-year-old male who is scheduled for an open coronary artery bypass graft. He has a history of hypertension, coronary artery disease, COPD, prostate cancer (treated 3 years ago by open prostatectomy, subsequent PSA is zero) and non-insulin dependent type II diabetes mellitus. His oxygen levels are 92%, his blood pressure is 150/95 mmHg and he reports that his fasting blood sugar levels tend to be around 140. He does not have any current acute illness or infection besides his cardiac condition. He arrived in the emergency department complaining of chest pain and pressure.

1. Identify what type of monitoring needs to be done.

1. Pulse Oximeter,

2. An Electrocardiogram (Ekg, Ecg)

3. A Temperature Probe.

4. Oxygen Analyzer And Carbon Dioxide Analyzer

5. Urinary Catheter

6. Transesophageal Echocardiograph.

7. Noninvasive Blood Pressure Monitors

8. Intravascular Pressure Measurements.

9. Capnography

10. Electroencephalogram

2. Explain what the monitoring is measuring

1.A pulse oximeter: a small instrument that is attached to your finger, toe, or earlobe to measure the level of oxygen in your blood.

2.An electrocardiogram (EKG, ECG): to monitor your heart activity. Small wires (leads) are placed on the skin of your chest and held in place by small adhesive patches.

3.A temperature probe: A monitor connected to your skin by a lead held in place by a small round adhesive patch may be used to measure skin temperature. A thermometer that is attached to a small tube inserted through the mouth into the esophagus after you are unconscious may be used to measure internal body temperature.

4.An oxygen analyzer and carbon dioxide analyzer on the anesthesia machine: These instruments measure the amount of oxygen and carbon dioxide gases inhaled and exhaled in your breath.

5.A urinary catheter.:This is a small, flexible tube inserted into the bladder to collect urine.

6.A transesophageal echocardiograph.:This instrument is inserted through the mouth and down the throat into the esophagus to monitor the heart.

7.Non-invasive methods for measuring blood pressure (BP) are not adequate for monitoring hemodynamic parameters during a cardiac surgical procedure, especially one that involves CPB. Because of the following limitations, they often are used merely as adjuncts to invasive BP monitoring.

8.Intravascular pressure measurements. In cardiac anesthesia, it is very common to measure pressures within blood vessels directly. Arterial pressure often is measured by placing a catheter in a peripheral artery, while other catheters are placed within the central circulation to measure the central venous or intracardiac pressures. The components of a system of intravascular pressure measurement are the intravascular catheter, fluid-filled connector tubing, a transducer, and an electronic analyzer and display system.

9.Capnography
End-tidal capnography offers evidence of endotracheal intubation on an immediate, noninvasive basis and now is considered to be part of the minimum standard of anesthetic care. It also provides continuous monitoring of the expired CO₂.

10.Electroencephalogram . The electroencephalogram (EEG) measures the electrical currents generated by the postsynaptic potentials in the pyramidal cell layer of the cerebral cortex. The basic principle of clinical EEG monitoring is that cerebral ischemia causes slowing of the electrical activity of the brain, as well as a decrease in signal amplitude. An experienced electroencephalographer can interpret raw EEG data from four or eight channels, but would be hard pressed to also administer an anesthetic and monitor other organ systems.

11.Arterial catheterization: For several reasons, arterial catheterization has become standard in the monitoring of the cardiac surgical patient:

a. Direct arterial pressure measurement is possible during nonpulsatile extracorporeal circulation.

b. Cardiac surgical patients usually are hemodynamically unstable in the perioperative period.

c. Close surveillance of arterial blood gases and other blood chemistries is indicated in these patients.

12.Central venous pressure. CVP measures RA pressure and is affected by one or all of the following: (a) circulating blood volume, (b) venous tone, and (c) RV function.

13.Echocardiography. Echocardiography, and especially has gained widespread use in the cardiac operating room.