Heart Rate Monitored in Only 2/3 of Surgeries

Cardiology monitoring skipped in more than 60 percent of high risk operations

(RxWiki News) During high-risk surgeries such as cancer, or spine or hip fractures, most patients would assume their heart would be monitored in the process. A new study reveals that's not usually the case.

Only 35 percent of anesthesiologists are monitoring the amount of blood that the heart is pumping during high risk surgeries, according to research presented at the European Anaesthesiology Congress in Amsterdam. Dr. Maxime Cannesson, an associate professor of anaesthesiology at the University of California, Irvine, the study's leader, is calling for action at the international level to ensure that cardiac output monitoring is utilized for all high risk surgical operations.

"Request cardiac monitoring during surgery."

The simple monitoring procedure can have a significant impact on how well patients recover following operations. A survey of 463 randomly selected European and U.S. anesthesiologists discovered that more than 95 percent of them knew it was critical that plenty of oxygen reached all parts of the body during surgery, which is determined by how well the heart pumps blood.

But 65 percent of them failed to do a simple monitoring procedure called cardiac output monitoring.

High risk surgery represents between 10 and 14 percent of the 240 million surgeries performed each year worldwide. High risk surgery includes operations on the liver, pancreas, aorta, most cancer surgery, and orthopaedic surgery, such as for spine or hip fractures.

Previous research has shown that when anesthesiologists measure and set goals for cardiac output during high risk surgery, patients have fewer complications following the operation, a shorter hospital stay and less will die during the postoperative recovery period.

Oxygen is used by the cells in order to produce energy and to fight the stress of the operation. If the cells and tissues do not receive oxygen during the surgery, they produce toxins, which can increase postoperative complications such as infection, kidney failure and pneumonia.

The primary reasons given for not monitoring cardiac output were that the cardiac output monitors were too invasive, that the anesthesiologists were using another cardiac output monitoring system such as checking variations in pulse pressure, and 30 percent believed cardiac monitoring did not provide important information.

Though cardiac output monitoring was once invasive, it is now a minimally invasive process that simply involves a catheter inserted into the pulmonary artery.

Researchers also said that surrogates such as pulse pressure variations cannot substitute for cardiac output measurements and have not been shown to improve the outcome of patients.

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Review Date: 
June 13, 2011