PhD defence J.J. (Jan) van Wijk

Below is a brief summary of the dissertation: 

This thesis explores the advancement of non-invasive monitoring in pediatric anesthesia, with a focus on improving gas exchange monitoring to enhance perioperative safety. It begins with a historical overview of anesthesiology, tracing its evolution from fundamental practices to a modern specialty emphasizing safety and monitoring. Technological milestones like pulse oximetry and capnography, along with global safety standards, have shaped current practices.
Chapters 2 and 3 focus on non-invasive monitoring modalities. The thesis highlights the challenges of pediatric monitoring, including accuracy and applicability of current technologies. It validates transcutaneous CO₂ sensors as reliable during pediatric anesthesia, though oxygen sensors (tcPO₂) are only dependable for infants under six months.
In Chapter 4, a clinical study on transcutaneous CO₂ monitoring during rigid bronchoscopies and microlaryngeal surgeries found no significant differences in ventilation outcomes, but spontaneous breathing led to lower CO₂ levels. These findings show clinical potential, though further refinement is needed.
Chapters 5 and 6 critique oxygen management practices. An international survey revealed wide variability in oxygen use, with common intraoperative hyperoxemia. A retrospective analysis confirmed that 89% of pediatric patients experienced excessive oxygen levels, highlighting the need for structured oxygen protocols.
Lastly, Chapter 7 introduces hyperspectral imaging as a tool for assessing bowel viability during neonatal surgery, demonstrating feasibility and potential for enhancing tissue perfusion assessment.
Overall, the thesis underscores the importance of accurate, continuous, and non-invasive monitoring, and calls for standardized guidelines to improve pediatric anesthesia safety.