Multimodal monitoring (MMM) in the perioperative period

Abstract

Routine anaesthesia monitoring until the mid-1980s often consisted of just a finger on the pulse, primitive ECG and intermittent blood pressure (MAP) measurement using a cuff and aneroid gauge or mechanical oscillotonometer. Then in quick succession an explosion of new monitors was introduced including pulse oximetry (SpO2), end tidal carbon dioxide (EtCO2) and anaesthetic agent monitoring as well as automated non-invasive blood pressure (NIBP) machines. These were all routinely in place in many hospitals by the late 1980‘s, but then progress came to a halt with no advances in routine anaesthetic monitoring for over 25 years. This paper concentrates on three classes of non- or minimally invasive monitors which have become additionally available in the last 10 to 15 years and if used in combination their potential impact on improving outcome following surgery in high risk patients: 1. Monitors which calculate stroke volume (SV, and thus cardiac output, CO) from a standard radial arterial line (e.g. LiDCO, UK), oesophageal probe (Deltex, UK), ECG pads or even from the finger 2. Monitors which assess the degree of cortical suppression (e.g. BIS, Medtronic, USA) produced by anaesthetics thus potentially allowing the administrator to "fine tune" anaesthesia for individual patients 3. Monitors which assess tissue oxygenation, usually of the brain (e.g. Invos, Medtronic, USA) If used together they provide complementary information which should improve perioperative haemodynamic management and outcome and form part of a multi-modal monitoring (MMM) strategy which is the subject of this article.