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Anaesthesia > Monitoring during anaesthesia > Flashcards

Monitoring during anaesthesia Flashcards

1
Q

what to monitor

A

Depth of Anaesthesia
Respiratory system
Cardiovascular system
Body temperature

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2
Q

written anaesthetic record - why

A

Helps identify trends during anaesthesia
Focuses the person on patient monitoring
Invaluable for personnel changeover
Legal record

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3
Q

Monitoring of the CNS

A

to ensure correct depth
Cranial nerve reflexes – Palpebral reflex, Ocular position, Pupil diameter, Jaw tone
Corneal reflex
Lacrimation
Salivation
Tongue curl
Cardiovascular indicators - HR, Capillary refill time, Arterial blood pressure
Respiratory indicators - Respiratory rate, depth and pattern

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4
Q

Monitoring of CVS Function - heart rate

A

Relative rate
Increase in rate – Surgical stimulation /Hypovolaemia
Decrease in rate – Increased depth of anaesthesia, Vagal activity

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5
Q

Monitoring of CVS Function - pulse

A

Heart rate
Quality – strength, relates to cardiac contractility
Rhythm – indicative of arrhythmias
Sites - Peripheral versus central pulse - Femoral, Lingual, Dorsal Pedal, Mandibular, Auricular

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6
Q

pale mucous membrane colour - cause

A

Alpha2 agonist administration
Anaemia
Vasoconstriction

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7
Q

Monitoring of CVS Function - Mucous membrane colour

A

Haemoglobin quantity
Peripheral blood flow
Respiratory adequacy
Toxaemia

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8
Q

Monitoring of CVS Function - Capillary refill time

A

Peripheral circulation

Normal < 2 seconds

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9
Q

oesophageal stethoscope

A

Useful if patient inaccessible

Information - Heart + Respiratory rate

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10
Q

Arterial Blood Pressure (ABP)

A

ABP = Cardiac Output x Systemic Vascular Resistance
Indirect indicator of cardiac output
Methods of monitoring - Non-invasive or indirect methods, Invasive or direct measurement

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11
Q

ABP – Doppler Flow Detection

A

Ultrasound Sensor distal to cuff - Piezo-electric crystal, Detect audible ‘swooshing’
Place pressure cuff around extremity Distal limb /tail
Advantages - Can use on conscious patients, Useful in hypotensive patients, Good in small animals, NOT horses, Underestimates sABP in cats 10 - 14 mmHg
Inflate cuff until no sound
Release cuff slowly until hear ‘swooshing’ sound - Indicates systolic pressure

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12
Q

ABP – Oscillometric Method

A 
Automatic 
Good for dogs 
Less reliable – Small cats. During hypotension 
HDO (High Definition Oscillometry) 
Expensive
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13
Q

central venous pressure - indicator of

A

Volume load / deficit
Adequacy of fluid therapy
Heart performance / failure

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14
Q

respiratory monitors

A

observation of chest wall / rebreathing bag
Heated probe monitors – sense expired gas
Respirometer – minute ventilation, e.g. Wright’s
End-tidal carbon dioxide – capnography

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15
Q

pulse oximetry

A 
Non-invasive continuous method 
Haemoglobin oxygen saturation 
Oxygenation of tissues NOT ventilation 
Normal > 95% O2 saturation
During + after anaesthesia
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16
Q

pulse oximetry - indicator of

A

Arterial oxygen saturation
Heart rate
Pressure wave form – peripheral circulation

17
Q

pulse oximetry - method

A

Sensor – (LED) - Red + Infrared
Photodetector - detects PULSATILE signal = arterial blood
Differential absorption of red + infrared - Oxyhaemoglobin, `Reduced haemoglobin

18
Q

Pulse oximetry - Limitations

A

NOT adequacy of ventilation
Poor function if - Compromised circulation, Movement + Light sensitive, Extremes of heart rate
Anaemia – underestimates oxygen saturation
Carboxyheamoglobin – misreads as oxyHB > 100%
Methaemoglobin – absorbs both red and infrared light > 85%

19
Q

Capnography

A

Measures - End-tidal carbon dioxide (ET CO2)

Infrared light absorption – proportional to CO2 in gas, mass spectrometry

20
Q

capnography - indicator of

A

Gas exchange - Adequacy of ventilation
Indirect indicator of arterial carbon dioxide – Heart pumping blood to lungs - Cardiovascular performance
Metabolic level – CO2 production

21
Q

capnography - Hyperventilation

A

decreased ETCO2

22
Q

capnography – Hypoventilation

A

Increased ETCO2

23
Q

capnography - limitations

A

Sampling error – falsely low ETCO2
Tachypnoea - Incomplete exhalation of alveolar gas, Dilution of alveolar gas by physiologic dead space gas
Equipment delay in response time
High fresh gas flow rates - Wash out end-tidal gas
Hypoventilation - Aspirate gas without CO2 in expiratory pause

24
Q

arterial blood gas supply

A

Definitive information on ventilation
Information on metabolic status
Measures - Oxygen, Carbon dioxide, pH

25
Q

hypothermia

A 
Reduced anaesthetic requirements 
Slowed drug metabolism 
Prolonged recovery 
Shivering in recovery 
Greater risk of complications
26
Q

hyperthermia

A

Malignant hyperthermia
Pyrexia
Rebreathing circuits on a warm day

Anaesthesia (7 decks)

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