Hemodynamic monitoring is fundamental to anesthesia care, ranging from basic noninvasive blood pressure to advanced cardiac output monitoring. The shift from static measures (CVP, PAOP) to dynamic assessment of fluid responsiveness has transformed perioperative hemodynamic management. Understanding the principles, limitations, and appropriate application of each monitoring modality enables rational, evidence-based hemodynamic optimization.
Arterial line waveform: systolic upstroke reflects contractility, dicrotic notch reflects SVR, pulse pressure reflects stroke volume
CVP alone is a poor predictor of fluid responsiveness; dynamic indices (PPV, SVV) are superior
Pulse pressure variation (PPV) >13% in mechanically ventilated patients predicts fluid responsiveness
Goal-directed fluid therapy (GDFT) with stroke volume optimization reduces complications in high-risk surgery
Noninvasive cardiac output monitors (FloTrac, ClearSight) provide trends but may be less accurate in vasoplegia
A passive leg raise (PLR) test is the most reliable bedside predictor of fluid responsiveness in both spontaneously breathing and mechanically ventilated patients. A >10% increase in stroke volume or cardiac output after PLR predicts response to a fluid bolus.
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