Clinical Monitoring in Anesthesia Flashcards
Standards for minimum requirements set by the
AANA
Standards for monitoring
Set a legal precedence
Morbidity and mortality decrease
When was standards for monitoring established
1974
Expected standard of care established by
JCAHO
Harvard established also in
1986
Which standard number
Standard V professional practice manual
What are the standards for monitoring
Ventilation Oxygen Circulation Body Temperature Neuromuscular function Positioning
AANA standard for Ventilation
Continuous ETCO2 monitoring
Verify intubation by (3)
Auscultation
Positive chest excursion ( Bilaterally)
Presence of Exhaled CO2
AANA Standards for Oxygenation
Continous clinical observation
Continuous Pulse Oximetry
ABG (if indicated)
AANA Standards for Circulation
Continous ECG and heart sounds
KEEP volume level where you NEED to hear it
BP and HR at least q5minutes
AANA Standards for Body Temperature
Continuous monitoring on all PEDIATRIC patients receiving GA
Goal for body temperature
GREATER than 97F
LESS Than 97, WRITTEN UP
The colder the patient
the longer the anesthetics stay on board
Neuromuscular blockade need
Train of Four q15 minutes
Need to show proof of
Reversal of agent need to be documented
Reverse with
Neogstigmine and Glycopyrrolate
INVASIVE monitors
Foley
Arterial line
CVP
PA catheter
Urine output
1 ml/kg/hr
Case over 3 hours, what may be indicated?
Foley may be indicated
Brown port
CVP , position of the bed
Ditstal port
Brown
Your senses is
the ART of anesthesia
Vigilance include
Vigilance, sight, hearing, Touch, smell
Stethocoscope
Precordial vs Esophageal
Required for every PEDIATRIC patient
Precordial
Precordial does what
Metal chest piece connected Easily detect changes in breath and heart sound EndoBRONCHIAL INTUBATION (
Mainstay of intubation
Capnography
Sampling port by
Elbow of the circuit
To analyze the particle size and the concentration of the gas both inspired and exhaled
MASS SPECTOMETER
Which part of the most important to monitor
EXHALATION of the gas
Most soluble
Isoflurane
Least soluble
Desflurane
ETCO2 scavenging
None
Clinical Application of Capnometry best indicator of MH
Increased CO2
If CO2 start dropping
Monitor BP (estimate Co)
Respiration Mandatory
Apnea monitor
Hyperventilating (CO2 low) for craniotomy
Decrease CBF (CO2 low to 20 mmHg)
Mannitol in craniotomy
decrease brain volume and Diuresis
Phase of CApnograpy
I- IV
Phase I is
Dead space Ventilation
Baseline elevattion indicates
CO2 absorbent exhausted
Incompetent ex or inspiratory valve
Bain circuit flow too low
CO2 should be
Zero unless rebreathing occurs
PHase II
Exhalation , should be steep
Prolonged upstroke of Phase II
Mechanical obstruction
Slow emptying of the lungs (COPD/ Bronchospasm)
Phase III is
Plateau
Phase III represents
maximum CO2 at end of phase
Right main stem would see
Change in Phase III
Phase IV
Inspiratory phased
Prolonged phase IV
Restrictive lung disease
Smaller and smaller Waveerform
Endobronchial or ESOPHAGEAL intubation
Decreases height of capnography
Decrease in CO
Esophageal intubation
smaller waverform of CO2
Waveform increasing , gradual
Hypoventilating
Long inspiratory phase
sticky inspiratory valve
Cardiogenic Oscillations
Artifarct
O2 analyzer
Inspiratory limb
Require pulsatile (issues with cold finger)
Nitro paste on finger, put pulse ox back on
Oximetry involves the measurement of oxyhemoglobin (HbO2) concentration based on the
Lambert-Beer law
IV dye will
Pulse ox will decrease
O2 saturation is
directly proportional to the hemoglobin
SaO2 30 is
60
SaO2 40 is
75
No waveform
Digital palpation
No CO
NO pulse ox
Most commonly used is
Lead II
Too small
Falsely high readings
Too large
falsely low readings
Correct size is
20-50% > than diameter of patient extremity
