PS18 2017: Monitoring during anaesthesia

List:

· General comments

· Human monitoring

· Sedation

· Major regional

· General anaesthesia

Not quite accurate:

	Sat probe	BP cuff	ECG	Capno
Sedation	+	+
Regional	+	+	+
General	+	+	+	+

N.B. GA also requires modern anaes machine with O2 and pressure alarms

General comments:

· Anaesthetist must ensure all required monitoring equipment is available

· Monitoring requirements are case-dependent

· Alarms must be enabled and noisy

· Data must be documented

Human monitoring:

· Monitors do not replace vigilance and situational awareness

· Anaesthetist must be present from go to woe

· Brief absence ok so long as a competent assistant is present

· Permanent handover can only be to another anaesthetist

Sedation:

Airway and breathing

· Ventilation: observation

· Oxygenation: SpO₂

Circulation

· Pulse rate (i.e. SpO₂)

· Blood pressure (omission must be justified)

· Intervals ≤ 10 minutes

Must be available

· ECG

· Capno

(Major regional: sedation monitoring + ECG)

Major regional:

· PS18 (this document) says NIBP + ECG

· PS03 (regional document) says NIBP + RR + conscious state, with pulse ox and ECG available

General anaesthesia:

Airway and breathing

· Ventilation: capno, circuit disconnection alarm, ventilation failure alarm

· Oxygenation: SpO₂ + circuit oxygen analyser

Circulation

· Pulse rate (i.e. SpO2)

· NIBP (omission must be justified e.g. brief paeds case)

· ECG

· Intervals ≤ 10 minutes

Must be available

· Invasive arterial BP monitoring: if sick enough

· Inhaled anaesthetic concentration: if in use

· Temperature: if being actively warmed

· Neuromuscular: if paralysed (and TOF ≥0.9 for extubation)

· Processed EEG: if at risk of awareness

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