Page 43 - ANZCP Gazette MAY 2014

NEURO MONITORING – BEYOND THE EEG
Techniques for monitoring the brain have moved well beyond the classical electroencephalogram, to include the monitoring of brain pressures, blood flow and metabolism. Invasive techniques permit the direct monitoring of tissue oxygenation, focal blood flow, pressure and cerebral metabolites, which have important applications in the Neuro- intensive care setting. Noninvasive tools for neuromonitoring are performing an increasingly
essential role in cardiothoracic surgery, driven by the need to ensure adequate cerebral oxygenation during procedures requiring selective cerebral perfusion.
This talk will give an overview of techniques for haemodynamic and metabolic neuromonitoring, with a focus on noninvasive techniques and their application in cardiovascular perfusion.
Philip M. Lewis
Dept of Neurosurgery, Alfred Hospital, Melbourne.
ROTEM 2013 – WHERE ARE WE AT?
Dr Ian Smith MBBS FANZCA PGdip Periop Echo
Department of Anaesthesia and Pain Management, Royal Children’s Hospital Melbourne, 50 Flemmington Rd, Parkville 3052, Melbourne, VIC, Australia
Measurement of the in-vitro thromboelastographic properties of whole blood by ROTEM can provide qualitative and quantitative assessment of the intrinsic, extrinsic and common pathways. In addition, it provides information on heparin activity and the degree of activation of the fibrinolytic pathway. Its ability to provide rapid point-of-care data makes it a useful tool in the assessment of the in-vitro integrity of the coagulation system. It has the potential to guide clinicians in the choice of factor replacement for the specific coagulopathic conditions identified thereby reducing unnecessary patient exposure to blood products.
The objectives of this presentation are to provide:
1. An overview of the TEG and the ROTEM to look at the parameters measured, their similarities and differences.
2. AnalysisofthecorrelationofROTEMparameterswithrespect to the TEG and standard laboratory coagulation data.
3. A review of outcome data where ROTEM data has been used to guide therapy.
4. Anopinionofwherewearein2013inAustralasiawithregards to the use of the ROTEM and offer an alternate strategy.
5. A glimpse into the future of the ‘third generation’ machine being developed here in Melbourne.
The role of ROTEM within Australasia has yet to be defined. Reference ranges will need to be completed for the local populations. Within the context of paediatric cardiac surgery these will need to have appropriate age cohorts. Clear strategic guidelines need to be developed in conjunction with sound clinical trials to validate the utility of ROTEM guided factor replacement in the Australian population before its widespread adoption should occur.
MAY 2014 | www.anzcp.org
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