Multimodal monitoring (MMM) in the perioperative period

Routine anaesthesia monitoring until the mid-1980s often consisted of just a finger on the pulse, primitive ECG and intermit-tent blood pressure (MAP) measurement using a cuff and aneroid gauge or me-chanical oscillotonometer. Then in quick succession an explosion of new monitors was introduced including pulse oximetry (SpO2), end tidal carbon dioxide (EtCO2) and anaesthetic agent monitoring as well as automated non-invasive blood pres-sure (NIBP) machines. These were all rou-tinely in place in many hospitals by the late 1980’s, but then progress came to a halt with no advances in routine anaesthetic monitoring for over 25 years. 

This paper concentrates on three classes of non- or minimally invasive monitors which have become additionally avail-able in the last 10 to 15 years and if used in combination their potential impact on improving outcome following surgery in high risk patients:tary information which should improve perioperative haemodynamic manage-ment and outcome and form part of a multi-modal monitoring (MMM) strategy which is the subject of this article. 

cardiac output, minimally inva-sive, tissue oxygenation, depth of anaesthe-sia multi-modal monitoring

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