Purday J P
Department of Anaesthesia, University of British Columbia, British Columbia's Children's Hospital, Vancouver, Canada.
Can J Anaesth. 1994 Sep;41(9):818-44. doi: 10.1007/BF03011590.
Monitoring of paediatric anaesthesia has become increasingly more complex in recent years and this is particularly true of cardiac anaesthesia. The purpose of this review is to give a comprehensive update of published material related to both routine and specialized cardiac monitoring. Routine monitoring can be particularly affected by the alterations of cardiac rhythm, blood flow, cardiac output and oxygenation which result from the congenital heart abnormalities themselves, the type of surgery undertaken and the effects of cardiopulmonary bypass. The use of specialized monitoring is becoming more widespread, particularly in the areas of cerebral function, mixed venous oxygenation, cardiac output measurement and coagulation. In the last five years, with the development of smaller probes, a great deal has been published on transoesophageal echocardiography. The use of the current monitors of cerebral function still remains controversial despite the need for a monitor of adequate brain perfusion, reflecting the need for a great deal of further research in this area. This review will concentrate on particular areas which have seen the most profound changes and on monitoring that may form the standards of tomorrow. Finally, amongst all the technology, it should not be forgotten that the most important clinical monitor is the bedside clinical monitoring of the physicians themselves.
近年来，小儿麻醉监测变得越来越复杂，心脏麻醉尤其如此。本综述的目的是全面更新已发表的与常规和专门心脏监测相关的材料。常规监测可能特别受先天性心脏异常本身、所进行手术的类型以及体外循环的影响所导致的心律、血流、心输出量和氧合变化的影响。专门监测的应用越来越广泛，特别是在脑功能、混合静脉氧合、心输出量测量和凝血领域。在过去五年中，随着更小探头的发展，关于经食管超声心动图已经发表了大量文章。尽管需要监测足够的脑灌注，但目前脑功能监测仪的使用仍存在争议，这反映出该领域需要大量进一步的研究。本综述将集中于那些发生了最深刻变化的特定领域以及可能成为未来标准的监测方法。最后，在所有这些技术中，不应忘记最重要的临床监测是医生自己在床边进行的临床监测。
