Advanced Hemodynamic and neurologic monitoring in Emergency CABG

ECG and invasive arterial blood pressure and CVP monitoring are routine monitors for CABG.Additional and advanced monitors for CABG particularly for emergent CABG are:1. PAC: No evidence of improved outcome with PAC use. However, Commonly used for treatment guidance in conjunction with TEE monitoring and for post operative care in the ICU, Particularly in patients with severely reduced ventricular function and those with pulmonary hypertension.2. 2)New monitors with capability of continuous monitoring of cardiac output (C.O), SVO2, SVR, RVEF, PAP and PAOP and many other parameters by specific PA catheters and other minimally invasive monitor for continuous C.O, S.V and SVR monitoring by a peripheral arterial catheter are advanced hemodynamic monitoring in elective and emergent CABGS.3. TEE : TEE use in patients undergoing CABG can provide invaluable information beyond ischemia detection. TEE is Recommended for all cardiac operations.It can assist in pre-CPB evaluation of cardiac function , associated valvular lesions, evaluation of Atherosclerotic plaques in the aorta , position of canula, volume status ,ventricular function , response to inotropic agents and de- airing.4. Neurophysiologic monitoring: Increasing report that cerebral oximetry aids in detecting catastrophic events. cerebral oximetry has these advantages:continuous vigilance, immediate warning, simple interventions and improved outcomes .it monitors brain oxygenation at critical levels and at high sensitivity and well suited for all type of cardiovascular procedures –Not pulse, pressure or temperature dependent. So that co is one of the multimodality neuromonitoring for emergent CABG. Absolute values below 50 or decrease in rso2 of 20% from awake baseline are cause for Concern and initiation of intervention