Routine clinical monitoring
Clinical examination. The complexity of conditions encountered during cardiac surgery combined with relatively restricted patient access mandates the use of reliable, objective monitoring. Decision-making should always incorporate whatever clinical observations are available, but these rarely suffice during cardiac operations. While the anesthesiologists typically only has access to the head and neck, physical examination of these areas may be of critical importance. For example, unilateral facial blanching may indicate arterial (aortic) cannula malposition whereas chemosis and facial edema and flushing may indicate SVC obstruction. Electrocardiography. Initially used exclusively for detection of arrhythmia, ECG monitoring has undergone technological advances that have substantially expanded the information that can be derived. However, there are a number of unique challenges to ECG monitoring in the intraoperative setting that require a detailed knowledge of its technical principles and pitfalls in order to assure reliable and effective use. The goals of intraoperative ECG monitoring are summarized in Table 22.1.
