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BY DR JOGESH AHUJA
PURPOSE OF MONITORING
Monere-to warn.
Measure physiological variables Indicate trends of change Enable appropriate therapeutic action to be taken
They are intended to encourage quality patient care, but observing them cannot guarantee any specific patient outcome
These standards are not intended for application to the care of the obstetric patient in labor or in the conduct of pain management
STANDARDS
I Qualified anesthesia personnel shall be present in the room throughout the conduct of all general anesthetics, regional anesthetics, and monitored anesthesia care
II During all anesthetics, the patient's oxygenation, ventilation, circulation, and temperature shall be continually evaluated
Oxygenation To ensure adequate oxygen concentration in the inspired gas and the blood during all anesthetics Ventilation To ensure adequate ventilation of the patient during all anesthetics Circulation To ensure the adequacy of the patient's circulatory function during all anesthetics Body Temperature To aid in the maintenance of appropriate body temperature during all anesthetics
Indication use of any anaesthetic Methods Palpation; Doppler; Auscultation; Oscillometry Contraindications avoided in extremities with vascular abnormalities
Indications - induced hypotension, anticipation of wide blood pressure swings, end-organ disease necessitating precise beat-tobeat blood pressure regulation, and the need for multiple arterial blood gas analyses Method by direct cannulation of artery Contraindication arteries without extremities with vascular insufficiency collateral blood flow,
Commonly used is Radial artery, Ulnar artery, Brachial Artery; Lower limb arteries are best avoided
ECG
Treatment
anesthesia deep volume nerve reaction vasoactive drugs
Treatment
Remove aetiology Vasoactive drugs
Treatment
Treat the cause Anti Ischemia measures eg Nitrocontin, adjusting ventilator function
Respiratory function:
Tidal volume, minute ventilation, airway pressure, peak pressure, respiratory rate, PEEP, oxygen concentration
Depending on a particular patient's oxygenhemoglobin dissociation curve, a 90% saturation may indicate a PaO2 of less than 65 mm Hg
Oxygen analysis
To measure fiO2 in inhaled gas mixture No contraindications to this measurement Uses either Galvanic cell principle or Paramagenetic analysis
TEMPERATURE
The temperature of patients undergoing general anesthesia should be monitored.
Very brief procedures (eg, less than 15 min) may be an exception to this guideline. No contraindication to this measurement Delirious effects of Hypothermia (Temp less than 36 degree during anaesthesia
Cardiac arrhythmias and ischemia Increased peripheral vascular resistance Left shift of the hemoglobinoxygen saturation curve Reversible coagulopathy (platelet dysfunction) Postoperative protein catabolism and stress response Altered mental status Impaired renal function Decreased drug metabolism Poor wound healing Increased incidence of infection
URINARY OUTPUT
Urinary bladder catheterization is the only reliable method of monitoring urinary output
Utmost care to catheterization as increased chances of infection Useful in CCF, fluid overload, renal failure, shock etc Inadequate urinary output (oliguria) is often arbitrarily defined as urinary output of less than 0.5 mL/kg/h