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Anesthesiologists are often involved in management and treatment of clinical patients in almost every department of their hospital. They are challenged with an ambitious monitoring task of their patient in the different settings. The SenTec Digital Monitoring System (SDMS) is supporting Anesthesiologists in clinical situations, such as:
- procedures involving special mechanical ventilation techniques (HFJV, HFO, One-Lung ventilation) or prolonged apneic phases (HFNC for apneic oxygenation/ventilation),
- monitored-anesthesia care / procedural sedation,
- monitoring of adverse effects of pain medication,
- and surveillance in the post anesthesia care unit.
In certain situations tcPCO2 monitoring provides better estimates of PaCO2 values in patients undergoing various surgical procedures (e.g. in thoracic anesthesia, anesthesia involving severely obese adults with ventilation/perfusion mismatch, and one-lung ventilation) than end tidal CO2 (ETCO2) monitoring.
TcPCO2 monitoring is also helpful during high frequency jet ventilation in e.g. upper airway laser surgery or trachea / lung surgical procedures. It is also used to control HFO or helps to guide the ventilation in one-lung ventilation procedures. During apneic phases TcPCO2 allows for continuous monitoring, especially when ETCO2 measurement is not possible e.g. during application of a high flow nasal cannula for surgical larynx or trachea procedures.
TcPCO2 doesn’t replace EtCO2 monitoring in the operation room (since EtCO2 immediately allows for detection of life-threatening situations), but TcPCO2 and EtCO2 monitoring are complementary measurements in many situations. TcPCO2 is a valuable addition to capnography in patients with an increased EtCO2/PaCO2 difference and in situations in which the continuous, noninvasive, and precise control of carbon dioxide level is required (e.g. one-lung ventilation).
The SDMS provides the anesthesiologist in the operating room a monitoring tool for estimating the patient's PaCO2 independent of the patient's lung ventilation/perfusion status in a fast, accurate and continuous way.
Procedural Sedation or MAC
Procedural sedation or monitored-anesthesia care (MAC) for diagnostic or therapeutic procedures with or without local anesthesia are often provided by the operator together with a trained nurse or in difficult cases an anesthesiologist is involved.
Procedural Sedation/MAC are indicated in e.g. the following diagnostic or therapeutic procedures: endoscopy, flexible fiberoptic laryngoscopy and bronchoscopy, cardiac catheterisation, electrical cardioversion, diagnostic imaging in children (MRI, CT), major dental procedures, extra-corporeal shock-wave lithotripsy, interventional radiology procedures, laceration repair in children, bone marrow aspiration, burn debridement/major abrasion cleaning (“road rash”), fracture reduction/dislocation reduction, thoracocentesis, thoracotomy/chest tube placement, central catheter placement.
Guidelines for sedation and/or analgesia by non-anaesthesiology doctors from the Section and Board of Anaesthesiology of the European Union of Medical Specialists recommend in terms of ventilation and oxygenation:
...monitoring should consist of a minimum of pulse oximetry and continuous visual observation of breathing and its frequency.
The American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists emphasizes:
...because ventilation and oxygenation are separate though related physiologic processes, monitoring oxygenation by pulse oximetry is not a substitute for monitoring ventilatory function.
The SDMS provides the medical doctors and nurses involved in procedural sedation settings with a single sensor application, which yields fast, accurate and continuous information about the ventilation (tcpCO2) and oxygenation (SpO2) status of their patients.
The Task Force on Postanesthetic Care of the American Society of Anesthesiologists report in their Practice Guidelines for Postanesthetic Care:
...It is recommended to assess airway patency, respiratory rate, and SpO2 during emergence and recovery and particular attention should be given to monitoring oxygenation and ventilation.
The detection of hypoventilation (induced by residual anesthetics, pain medication e.g. patient controlled analgesia (PAC) with e.g. opioids) by pulse oximetry alone will be impaired, if patients in the PACU receive supplemental oxygen therapy.
The SDMS helps the medical doctors in charge of the PACU to monitor their patients' ventilation and oxygenation status with one single sensor. Additionally with the V-CareNeT™ add-on package to the V-STATS™ Software, it is now possible to centrally monitor up to 20 SDMs connected to a standard Ethernet network on one PC-screen.