Anesthesia for Thoracic Surgery - Monitoring
Standard monitoring should be used as described in Chapter 10.
Intra-arterial blood pressure monitoring should be used if, based on the patient's condition or the nature of the surgical procedure, rapid hemodynamic alterations are anticipated, or frequent ABG evaluation is needed.
- Compression of the heart and great vessels may occur during thoracic surgical exposure. Continuous blood pressure monitoring allows for the immediate diagnosis of hemodynamic instability.
- Manipulations during surgical procedures on peripheral lung tissue, such as thoracoscopic wedge resection, are less likely to compress the heart or great vessels. Intermittent blood pressure monitoring may be sufficient in these cases.
- ABG measurements are helpful for the management of patients undergoing tracheal surgery, especially in the postoperative period.
- In the lateral position, it is possible for blood flow to the dependent arm to be impaired. Pulsatile flow to the dependent arm should be monitored with an arterial catheter or a pulse oximeter.
- During mediastinal surgery (e.g., tracheal reconstruction or mediastinoscopy), it is possible for the innominate artery to be compressed, restricting flow to the right carotid and brachial arteries. Perfusion to the right arm should be monitored by pulse oximeter or blood pressure cuff. Immediate feedback to the surgeon will allow decompression of the innominate artery. Blood pressure monitoring of the left arm should be available to allow monitoring of systemic arterial pressure in the event that the surgeon is unable to relieve compression of the innominate artery.
The use of additional invasive monitors is dictated by the patient's comorbidities. If a pulmonary artery catheter is placed:
- It is customarily inserted from the nondependent side of the neck. If the catheter interferes with the surgical resection, it can be retracted into the main pulmonary artery and readvanced when the artery on the operative side is clamped.
- Pressure measurements referenced to the atmosphere may be affected by lateral positioning and opening the chest. Trends in central venous pressure, pulmonary artery pressure, and pulmonary artery occlusion pressure should be monitored. Cardiac output and stroke volume measurements remain accurate.
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