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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