Monitoring Flashcards
AANA Standard 9
Monitoring:
- Ventilation
- Oxygenation
- CV status
- Body temp
- Neuromuscular function
- Position
Ulnar Nerve
Adductor policis → thumb adduction
Best site to monitor RECOVERY
Only quantitative site
Facial Nerve
Cranial nerve VII Temporal branch Orbicularis occuli → eyelid closure Corrugator supercilli → eyebrow twitch Best site to monitor ONSET
Posterior Tibial
Flexor hallucis → big toe flexion
Used to monitor recovery
Qualitative Nerve Monitoring
Subjective measurement
Muscle responses visible or palpated
Quantitative Nerve Monitoring
TOF ratio
Ulnar nerve
Requires baseline prior to paralysis
Assess waveform
Single Twitch
0.1-1 Hz
Requires baseline
TOF
4 twitches at 2Hz every 0.5 sec for 2 sec Reflects blockade at 70-100% Ratio compares T1-T4 0/4 100% 1/4 90% 2/4 80% 3/4 75% 4/4 70%
Double-Burst Suppression
Two short bursts at 50Hz
Easier to detect fade
Tetanus
Rapid delivery 30, 50, 100Hz stimulus for 5 sec
Painful - use sparingly for deep block assessment
Post-Tetanic Count
50Hz for 5 sec followed by 3 sec pause then single twitches at 1Hz
Useful only when TOF or double-burst absent
Pulse Oximetry
Requires pulsatile blood flow
SaO2 90 PaO2 60
Cyanosis = late sign
Interfere w/ Pox
High intensity light Movement Electrocautery Peripheral vasoconstriction Hypothermia CPB Methemoglobin Carboxyhemoglobin Methylene blue Hemoglobin <5
PACO2-PaCO2
2-10mmHg
Capnograph
X-axis (seconds)
Y-axis (ETCO2 mmHg)
Phase 1 baseline
2 upstroke
3 plateau
4 downstroke
α
β end expiration
