• Country: Hong Kong
  • Official Title: Queen Marry Hospital
  • Department: ANA/Pain/POM, Queen Mary Hospital (2023- present)
  • Institute: Honorary Clinical Associate Professor, University of Hong Kong (HKU) (2012-present)
  • E-Mail: cye254@hk.org.hk, yeeeot@gmail.com

Speech Title

Intraoperative Hemodynamic Monitoring術中血流動力學監測

Hemodynamic monitoring is an essential part of the perioperative management of the cardiovascular patient. It helps to detect hemodynamic alterations, diagnose their underlying causes, and optimize oxygen delivery to the tissues. Furthermore, hemodynamic monitoring is necessary to evaluate the adequacy of therapeutic interventions such as volume expansion or vasoactive medications. Recent developments include the move from static to dynamic variables to assess conditions such as cardiac preload and fluid responsiveness and the transition to less-invasive or even noninvasive monitoring techniques, at least in the perioperative setting. This review describes the available techniques that currently are being used in the care of the cardiovascular patient and discusses their strengths and limitations. Even though the thermodilution method remains the gold standard for measuring cardiac output (CO), the use of the pulmonary artery catheter has declined over the last decades, even in the setting of cardiovascular anesthesia. The transpulmonary thermodilution method, in addition to accurately measuring CO, provides the user with some additional helpful variables, of which extravascular lung water is probably the most interesting. Less-invasive monitoring techniques use, for example, pulse contour analysis to originate flow-derived variables such as stroke volume and CO from the arterial pressure signal, or they may measure the velocity-time integral in the descending aorta to estimate the stroke volume, using, for example, the esophageal Doppler. Completely noninvasive methods such as the volume clamp method use finger cuffs to reconstruct the arterial pressure waveform, from which stroke volume and CO are calculated. Current innovation of AI technology is also a new trend in hemodynamic monitoring, such as Hypotension Prediction Index and Assisted Fluid Management. Although there is still room to be improved, however the early insight of hemodynamic instability and novel parameter did bring more timely and comprehensive information to healthcare professionals. The potential of AI assisted personalized decision making would open a new pathway to advance patient care intraoperatively.