Monitoring During Anaesthesia

General Principles:

• Monitoring is essential during anaesthesia, and must be used in conjunction with clinical observation
  Vigilance is essential for safe practice.
  • Therefore, a proceduralist cannot also provide anaesthesia
• Person responsible for provision of anaesthesia must be constantly present from induction until transfer to PACU or ICU
  In exceptional circumstances, a brief absence may be unavoidable. In such instances, observation should be delegated to a suitably trained and skilled practitioner.
  • Permanent handover of responsibility can only occur to an anaesthetist who is able to accept that responsibility
• Duration of monitoring post-operatively relies on clinical judgment
• Presence of monitoring is the responsibility of the anaesthetist

Regular monitoring should include assessment and recording of:

• Oxygenation
  Continuously. Adequate light should be available.
  • Pulse oximetry is required for every GA or sedation
    Variable pulse tone and alarm should be set and audible.
  • An oxygen analyser (for low FiO₂) must be in continuous use for every case involving an anaesthetic breathing system
• Ventilation
  Continuously.
  • If an automatic ventilator is in use, an alarm for a disconnection must also be in use
  • ETCO₂:
    • Must be used for every GA
    • Should be available for every sedation
• Circulation
  Detection of pulse and blood pressure.
  • ECG must be available
  • ECG should be used for GA and major regional cases, if clinically indicated
  • NIBP should be:
    • Available for every GA
    • If used, measured no less than every 10 minutes
  • Invasive blood pressure monitoring should be available
• Awareness/Anaesthesia
  • Equipment to measure effect of anaesthesia on the brain should be available
  • End-tidal inhalational anaesthetic concentration must be used for every inhalational anaesthetic
• Extremities
  • Core temperature monitors should be:
    • Available for every patient undergoing GA
    • Used whenever warming devices are used
  • Neuromuscular function monitors:
    • Must be available if neuromuscular blockade is induced
    • Used prior to extubating a patient who has received a non-depolarising neuromuscular blocker

Alarms:

• Alarms are visual and audible
• Alarms should be enabled on commencement of anaesthesia
  
• Alarms should only be disabled in exceptional circumstances

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References

1. ANZCA. PS18: Guidelines on Monitoring During Anaesthesia.