Monitoring

Question 1

Canadian Guidelines to the Practice of Anesthesia and Patient Monitoring

Answer 1

• an anesthetist present: “the only indispensable monitor”
• a completed pre-anesthetic checklist: including ASA class, NPO policy, Hx and investigations
• a perioperative anesthetic record: HR and BP every 5 min, O2 saturation, End Tidal CO2, dose and route of drugs and fluids
• continuous monitoring: see Routine Monitors for All Cases

Question 2

Routine monitors for all cases

Answer 2

• pulse oximeter, BP monitor, electrocardiography and capnography are required for general anesthesia and sedation (Ramsey Sedation Scale 4-6), agent-specific anesthetic gas monitor when inhalational anesthetic agents are used
• the following must also be available: temperature probe, peripheral nerve stimulator, stethoscope, appropriate lighting, spirometer

Question 3

Pre-anesthetic checklist

Answer 3

SAMMM

Suction: connected and working

Airways: laryngoscope and blades, ETT, syringe, stylet, oral and nasal airways, tape, bag, and mask

Machine: connected, pressures okay, all meters functioning, vaporizers full

Monitors: available, connected, and working

Medications: IV fluids and kit ready, emergency medicines in correct location and accessible

Question 4

Elements to monitor

Answer 4

• anesthetic depth
■ inadequate: blink reflex present when eyelashes lightly touched, HTN, tachycardia, tearing or sweating
■ excessive: hypotension, bradycardia

• oxygenation: pulse oximetry, fraction of inspired O2 (FiO2)
• ventilation: verify correct position of ETT, chest excursions, breath sounds, ETCO2 analysis, end tidal inhaled anesthesia analysis
• circulation: pulse, rhythm, BP, telemetry, oximetry, CVP, pulmonary capillary wedge pressure
• temperature
• hourly urine output