Continuous blood gas monitoring with an intraarterial optode during one-lung anesthesia

Accuracy and clinical performance of a continuous intra-arterial blood-gas monitoring system during thoracoscopic surgery

“…Continuous intra-arterial blood-gas monitoring would be advantageous because changes in oxygenation and carbon dioxide elimination can be recognized and treated immediately. 1 The Paratrend 7 (Biomedical Sensors Ltd, Pfizer Hospital Products Group, High Wycombe, UK) is a fast-response intra-arterial blood-gas monitoring system which may be suitable for detection of rapid changes in arterial PO z , PCO 2 and pH values during thoracic surgery with OLV. It is currently the only commercially available intravascular blood-gas sensor system.…”

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“…The EABG system utilizes optodes which are externally attached to the arterial catheter (CDI 2000 Blood Gas Monitoring System: CDI-3M Healthcare, Tustin, CA), in an attempt to avoid the patient interface problems observed with the first IABG devices [15,16]. This on demand catheter allows direct blood gas analysis at the bedside [5,6,7,8,15] and significantly reduces the delay in obtaining results.…”

“…Based on the same optode technology as the EABG devices, this technique differs because the sensor is directly inserted into the arterial blood stream. Unfortunately, until recently none of these devices had demonstrated adequate clinical performance, [15,16,23,24,25,26]. Their consistency and reliability were unacceptable because of significant malfunctions and inconsistencies that were shown to be attributable to the intra-arterial environment [15].…”

“…Their consistency and reliability were unacceptable because of significant malfunctions and inconsistencies that were shown to be attributable to the intra-arterial environment [15]. Aberrant blood gas values, obtained particularly in cases of hypotension or vascular construction were attributed to the `wall-stress effect' on the sensing element [15,16]. …”

How often should we perform arterial blood gas analysis during thoracoscopic surgery?

“…One-lung ventilation (OLV) during thoracoscopic surgery may be associated with rapid and unexpected changes in arterial blood gas (ABG) values [1][2][3][4]. Intermittent ABG analyses are essential to assess blood gas status during thoracoscopic surgery because noninvasive techniques such as pulse oximetry [5][6][7], capnometry [8,9], and transcutaneous blood gas measurements [10,11] have major limitations and frequently fail to monitor the extreme blood gas changes observed during OLV.…”