Intraoperative Monitoring

Question 1

Name 2 forms of monitoring?

Specify components of each?

Answer 1

1. Machine monitors:
   Oxygen supply an d pressure in supply lines
   A/w pressure
   % oxygen in final gas mixture
   Must be checked and calibrated everday
2. Patient monitors:
   Clinical observations of vital function
   Complicated direct monitors of vital functions
   - invasine/ non invasive monitoring

Question 2

How will you clinically monitor depth of anesthesia?

Answer 2

Inspecting pupils at regular intervals

Question 3

Clinical observations for depth of anesthesia ( guedel) - 4 stages:

Answer 3

1. Anesthesia to LOC
2. LOC to automatic breathing onset
3. Aut breathing to resp paralysis:
   
   1. Aut breathing - cessation of eyeball mvmnt
   2. Eyeball to start of intercostal paralysis
   3. To completion of intercostal paralysis
      + cess. Eyeball mvmnt; equal pupils;
      straight ahead
   4. To diaphragmatic paralysis
4. From diaphragmatic paralysis to apnoea and death NO reflex and pupils dilated widely.

Question 4

Which Geudel stages are compatible with surgery

Answer 4

Stage 3 level 2&3

Not stage 4

Question 5

Name the special monitoring techniques in anesthetics? 8

Answer 5

Blood pressure measurement
  -automated / direct intra-arterial pressure
ECG
Peripheral pulse monitor and oximeter
Capnography
CVP
Peripheral nerve stimulation
BIS index
Temperature monitoring

Question 6

What does the BP measurement require?

Sizes incl.

Answer 6

Imflatable cuff with. (14cm adult) - upper arms
Pressure gauge (spygomanometer)

NB- diametre of upper arm + 20%
Differ in babies and in leg

Question 7

3 components of balanced anesthesia?

Answer 7

Analgesia
Mucle relaxants
Hypnosis (consciousness)

Middle: homeostasis/life