Survey of the use of oesophageal and precordial stethoscopes in current paediatric anaesthetic practice

Abstract

Use of the stethoscope as a continuous monitor has decreased and most anaesthetists feel it has been superseded by other monitoring. However, almost one-third of anaesthetists recorded critical incidents they had been involved with where an oesophageal or precordial stethoscope detected the incident early. Complications of these monitoring devices were rare and the main factors limiting their use was the presence of better monitoring, such as pulse oximetry and capnography, and lack of availability.

Detection of Respiratory Adverse Events in Pediatric Dental Patients Sedated With 0.75mg/Kg of Midazolam and Oxygen by Continuous Pretracheal Auscultation: A Prospective Randomized Controlled Trial

“…20 Although continuous auscultation was once in routine use, it has been largely abandoned with the advent of electronic monitoring, reportedly due to availability of better monitoring, discomfort, inability to hear other sounds or people, and lack of freedom of movement. 26 Use of the PTS can also be limited by observer dependence. Arguments both for and against the use of the stethoscope were published as early as 1987.…”

Challenges with pediatric anesthesia and intraoperative ventilation of the child in the resource‐constrained setting

“…5,10 A basic monitor such as a precordial stethoscope (Figure 1) while no longer used in some highincome settings, is still considered a crucial monitoring device as it provides real-time feedback on ventilation and heart rate and can alert the anesthesia provider to accidental extubation, endobronchial intubation or the development of adventitious breath sounds. 11 Unfortunately, the solution is not as simple as merely supplying monitors to these settings. Consider the introduction of side stream continuous capnography.…”

“…Continuous waveform capnography, despite being recommended by the WHO‐WFSA Anesthesia standards and being universally accepted as an essential patient safety monitor in high‐income countries, is not widely available outside major centers 5,10 . A basic monitor such as a precordial stethoscope (Figure 1) while no longer used in some high‐income settings, is still considered a crucial monitoring device as it provides real‐time feedback on ventilation and heart rate and can alert the anesthesia provider to accidental extubation, endobronchial intubation or the development of adventitious breath sounds 11 …”

A history of pediatric anesthesia: a tale of pioneers and equipment

“…Invasive intra‐arterial blood pressure measurement became possible with the development of transducers and size‐appropriate catheters (46,47). For years, the precordial stethoscope was the mainstay of pediatric monitoring championed by Robert M. Smith; regrettably, most practitioners no longer use this device routinely (48). Continuous electrocardiogram, a standard requirement, provides useful information regarding rate and rhythm; however, ectopic rhythms are rare now that sevoflurane has replaced halothane.…”