1.
LECTURER :UMAR TARIQ
MSC OTT/ANAESTHESIA

2.
 Monitoring during anaesthesia is mandatory to
evaluate the physiological well being of the
patient.
During anaesthesia basic monitoring
requirements are:
A. presence of anaesthesiologist
B. Checking of anaesthesia equipments.
C. Monitoring of patient

3.
 Anaesthetist should be present
through out the surgical procedure
as he is responsible for the patient,
whether surgery is performed in
GA, Regional or Sedation

4.
 Anaesthesia machine, circuits,
ventilators, and monitors should be
checked to avoid complications
related to monitoring.

5.
I. CLINICAL MONITORING:
Clinical assessment of patient through out the surgical
procedure is necessary to detect the early complications
Basic parameters include:
 Colour of patient
 Chest movement and pattern of respiration.
 Presence of lacrimation & sweating.
 Reaction of pupils
 Pulse
 BP
 Urine output
 Temperature

6.
II, INSTRUMENTAL MONITORING:
These include
1. Arterial blood pressure monitoring
2. ECG monitoring
3. CVP monitoring
4. Pulse oximetry
5. Capnography
6. Temperature monitoring

7.
Arterial blood pressure can be
measured either by:
 Non Invasive BP
 Invasive BP

8.
 In this method pneumatic cuff is applied proximal to
the point where the artery is palpated(usually radial)
 The cuff is inflated above the systolic pressure, the
onset of pulsation is detected as the cuff is deflated.
 A narrow cuff gives falsely high reading and a wide
cuff gives falsely low reading.
 Recommendation cuff widths are
2.5 cm for neonates, 5 cm for infants 6 cm for child
9 cm for teenagers 12 cm for adults
15 cm for large Adults

9.
 The width of cuff should be 40% greater than
patients arm.
 These instruments measure blood pressure at
set intervals automatically by automated
oscillometery.

10.
 IBP monitoring is required when
surgical or patient`s condition
mandates beat to beat information
i,e continuous monitoring of BP
 IBP is considered as gold standard
monitoring of BP.

11.
 Haemodynamically unstable patient.
 Frequent arterial blood sampling.
 Need for tight BP control

12.
 An indwelling teflon catheter is used to cannulate in
the radial artery
 Sometimes brachial ,ulnar ,femoral and dorsalis
pedis
 Cannula is connected to a transducer via a column of
bubble free heparinized saline at a pressure of 300
mmHg.
 The transducer converts pressure into an electrical
signal which is amplified and displayed as numeric
value.
 Before doing artery cannulation Allen`s test should
be done to assess the patency of ulnar artery and
radial artery.

13.
 ECG monitoring reveals the electrical activity of
the heart.
 In OT continuous monitoring of ECG is done by
using of ECG monitor
 This monitor is connected to the patients chest by
electrodes which gives full details of the electrical
activity of the heart.
 Mandatory monitoring to detect:
Arrhythmia
Ischemia
Cardiac arrest

14.
 Ideal vein for monitoring CVP is right
internal jugular vein(because it is valve
less and in direct communication with
right atrium).
 CVP can also be measured by sub-
clavian, basilic and femoral vein

15.
 Major surgeries where large fluctuations in
hemodynamic are expected
 Open heart surgeries
 Fluid management in shock
 Parenteral nutrition
 Aspiration of air embolism
 Normal CVP is 3-10 cm of H2O (2-8 mmHg)
 In children 3-6 cm of H2O
 CVP more than 20 cm 0f H20 indicates right
heart failure

16.
 Fluid overloading
 Congestive heart failure
 Pulmonary embolism
 Cardiac tamponade
 Intermittent positive pressure ventilation with
PEEP.
 Pleural effusion
 Haemothorax
 Coughing and straining

17.
 Hypovolemia and shock
 Venodilators
 Spinal /epidural anaesthesia
 General anaesthesia (by causing vasodilation)
A low CVP with low BP indicates hypovolemia
while a high CVP with low BP indicates pump
failure.

18.
 It is to measure the oxygen saturation in blood

19.
A sensor with both red and infra red light at
wavelength 660nm(red) and 940nm(infrared)
passes through the tissue containing blood
While absorption of both wavelengths by the
blood is measured and oxygen saturation can
be calculated.

20.
 Probe is applied on fingers nail bed, toe
nail bed, ear lobule, tip of nose.
 Normal spO2 is 97-98%
 Pulse oximeter is used for detection of
hypoxia in intraoperative and
postoperative period

21.
 Anaemia : severe anaemia under-estimation of actual values.
 Nail polish (blue colour) shows false reading
 Shivering : constant movement of finger shows false reading.
 Skin pigmentation
 Dyes: e.g. methylene blue or green.
 Hypovolemia and vasoconstriction - in cold temperature
 Carboxyhaemoglobinemia: shows fix saturation of 95%
 Methhemoglobinemia : shows fix saturation of 85%
 Vasodilation : slightly decrease

22.
 It is a continuous measurement of end tidal
(expired) carbon dioxide (ETCO2) and its wave
form.
 Normal is 32-42 mmHg.
 It works on principle that infrared light is
absorbed by carbon dioxide.
 Capnography is a very important and sensitive
tool for monitoring in anaesthesia

23.
 Used in all anaesthesia & intensive care to monitor
the inhaled & exhaled concentration of CO2
 CO2 monitoring - basic standard for all patients
receiving GA - as suggested by ASA guidelines.

24.
Side stream capnometers
 Sensor is located in the main unit and carbon dioxide is
aspirates via a sample tube connected to a circuit
Advantages :
 Accurate capnography when attached as close as
possible to the patient.
 Light weight
 Used to measure CO2 and anaesthetic gases.
Disadvantages :
 Condensation of humidified gases
 Delay in measurement

25.
MAIN STREAM CAPNOMETRY
 Directly attached to the airway side.
Advantages :
 Fast response time
Disadvantage :
 Bulky equipment placed directly in ET tube.
 Anaesthetic gases not allowed to measure.

26.
ETCO2 = 0 and flat line on wave form is seen in :
1. Oesophageal intubation
2. Accidental extubation
3. Complete obstruction
4. Disconnection
5. Ventilation failure
6. Cardiac arrest( there is no blood to carry CO2 from
tissue to lungs)

27.
 Pulmonary embolism by air , fat or thrombus (
it may become zero if embolus is large enough
to block total pulmonary circulation)
NO CHANGES IN ETCO2:
Bronchospasm : CO2 has got very high
diffusibility therefore ETCO2 remain normal
even in severe bronchospasm

28.
 Exhausted soda lime or defective valves of
closed circuit which impairs the absorption of
soda lime by carbon dioxide
 Fever
 Malignant hyperthermia

29.
 Used for early diagnosis of hypothermia
 A temperature probe(using a thermistor or a
thermocouple) can be inserted at various sites,
like
o Tympanic membrane
o Skin
o Bladder
o Oesophagus
o Rectum
o nasopharynx

30.
 Urinary bladder catheterisation is the only
reliable method of monitoring.
 Indicated in patients with congestive heart
failure, renal failure, hepatic disease and shock.
 Lengthy surgeries and intraoperative diuretic
administration are other indications
 Should be done with utmost care in patients
with high risk of infection.