Using of studies Pdf Study material

1. Monitoring during
Anaesthesia & it’s
complication.

2. Contents...
1. Introduction
2. What should be monitored
3. Types of monitors
4. Basic monitoring
5. Advance monitoring
6. Temperature monitoring
7. Blood loss monitoring
8. Conclusion.

3. Introduction...
Importance of monitoring...
 To provide safety in the preoperative period.
 To avoid surgical and anesthesia complications.
 To prevent from physiological Disturbances.

4. Wt should be monitored...
 Circulation ( cardiovascular)
 Ventilation ( respiration)
 Oxygenation ( cardioresporation)

5. Types of monitors...
 Basic monitoring.
 Advance monitoring.

6. Basic monitoring...
 Pulse rate.
 Color Of skin
 Blood pressure
 Precordial and oesophageal Sthethoscopy.
 Signs of sympathetic Over activity
 Urine output.

7. Advance monitoring...
Advance monitoring.
Respiratory
Temperature
CNS
Cardiovascular
Blood loss

8. Cardiovascular system..
CVS
Non
invasive. Invasive.
Semi
invasive

9. Non – invasive monitoring....
1.ECG...
• detect cardiovascular problems during perioperative period.
• detect arrythmias., ( lead 2 )
• detect ischemia. (V5)
Timings : it should be monitored throughout the surgery until recovery.
Leads : Either 3 leads or 5 leads are used.
Complications :
 Patient refusal
 Allergy to adhesive tapes.

10. 2. Non invasive blood pressure :
It is used to detect systolic and diastolic pressure automatically at set intervals.
Frequency of measurement :
 By default every 5 minutes.
 For spinal anesthesia every 3 minutes.
 For GA every 5 minutes
 For monitored anesthesia care pt it should be monitored for every 10minutes.

11. Complications in NIBP :
 Nerve damage.
 Compartmrnt syndrome.
How to Treat intraoperative hypotension and hypertension
1. Intraoperative Hypotension Can be managed with fluids.
2. Etomidate is preferred for pre existing hypotension pt.
3. Hypotension is common in spinal anesthesia
4. Patient with pre existing hypertension , suitable drug should be given prior.

12. Semi invasive monitoring...
Transoesophageal echo :
 It is use to detect the abnormalities at the wall of The heart.
 Most commonly used in cardiac surgeries.
It is far from the setup.
Complications :
 Damage to teeth, throat, oesophagus
 Breathing problems.
 Bleeding.

13. Invasive monitoring..
1. Invasive blood pressure :
 It is used in patient for beat to beat monitor .
 Accurate monitoring is obtained
 It is called gold Standard period
 Difference between nibp and ibp will be 8 mmhg
Sites
1. Radial artery
2. Femoral artery
3. Brachial artery
4. Dorsalis pedis artery

14. How to choose artery :
Allens test
Normal - <7sec
Boderline – 7 to 14s
Risk - more than 15s.

15. Complication
1. Artery damage
2. Thrombosis, embolization
3. Sepsis
4. Tissue necrosis
Prevention :
Continuous flush with / without heparin.

16. 2. Central venous pressure :
 It is direct method of measuring blood pressure through the central veins that is
close to the heart.
Ie junction of superior vena cava and rt atrium.
Sites:
1. Rt internal jugular vein
2. Subclavian
3. Basilic
4. Femoral vein.
Normal value : 3 to 10cm of h20
Children’s : 3 to 6 Cm of h20.

17. Indications :
1. Open heart surgeries
2. Major surgeries
3. Fluid management in shock
4. Parenteral nutrition
5. As venous access.
6. Aspiration of air embolism.

18. Increases Decreases
• Fluid overload • Hypovolemia
• Congestive cardiac
failure
• Shock
• Pulmonary embolism • Spinal / epidural
• Pleural effusion • Venodilators
• Coughing and straining • GA drugs causing
vasodilation.
• Haemothorax.
CVP conditions increasing and decreasing...

19. Complications :
 Air embolism
 Thromboembolism
 Pneumothorax/ haemothorax
 Sepsis
 Cardiac perfusion
 Trauma to brachial plexus, carotid artery, and airway during insertion.
 Sepsis ( late complication)

20. Prevention :
 Sterile techniques
 Avoid ointments
 Disinfect cathether hub
 Avoid difficult Cathetherization
 Dont change cathether route often
 Remove no more usage
 Prefer subclavian.

21. 3 . Pulmonary artery catheterization :
 It is an invasive method by inserting a cathether to the vessels between heart and lung to detect the blood clots and
other cvs prblms.
 It is AKA swan-gazz cathertization.
Indications :
 Pulmonary hypertension
 Assesement in shock
 Pericardial tamponade
 Measure cardiac output ; RA pressure ; LA pressure.

22. Complications :
 Rupture to pulmonary artery
 ThrombOsis
 Bleeding.
 Pneumothorax.

23. Respiratory system...
1. Pulse oximeter
2. Capnography
3. ABG
4. Lung volumes
5. Oxygen analysers
6. Airway pressure monitoring
7. Apnea monitoring.

24. 1. Pulse oximeter :
Indication :
 To measure oxygen saturation in blood.
 To detect intraop and post op hypoxia
Normal – 97 to 100%
Errors:
1. Carboxyhaemoglobinenia
2. Methhemoglobinemia
3. Anemia
4. Hypovolemia and vasoconstriction
5. Vasodilation
6. Nail polish
7. Shivering
8. Dyes.

25. PRINCIPLE:
 Pulse oxymeter works on the principle of BEER-
LAMBERT law ,which states that different solvents
absorb infrared at different wave lengths.
 A pulse oxymeter probe emits two lights of
different wavelengths.(Red-660nm& infrared -
940nm).
 Oxyhemoglobin absorbs more infrared light.
 Deoxyhemoglobin absorbs more red light.

26. Co oximeter :
It is special type of oximeter use to detect spo2 between normal and abnormal
hemoglobin.
Complication :
1. False reading
2. Pressure sores / burns.
Sites:
Finger nail bed, toe nail, ear lobule, tip of nose.

27. 2 . Capnography :
It is used to monitor the partial pressure of co2 during anesthesia.
Normal value : 32 to 42 mmhg.
Uses:
1. It is used to confirm tube position
2. To control level of hypocapnia and hyperventilation in neurosurgery.
Principle : infrared light is absorbed by carbon dioxide.

28. Changes in waveform :

29. Etco2 = 0 Etco2 decreases No change Etco2 increases
1. Esophageal
intubation
1. Pulmonary
embolism
1.Bronchospasm 1.Exhausted
sodalime
2.• Accidental
extubation ,
•Obstruction
•disconnection
• ventilation failure
2. Decreased co2
production in
hypothermia
2. Increase
production in
hypermetabolic
status.
3. Cardiac failure. 3. Hypoventilation

30. 3. Blood gas analysis :
Blood gas analysis is used to detect the oxygenation , acid base balance and
ventilation during perioperative period.
Sites : radial ; brachial ; femoral artery
Things to be seen in abg:
Oxygenation : pa02, So2
Ventilation : Pco2
Acid base balance : ph, Hco3

32. Others
4. Lung volume – spirometer
5. Oxygen analysers –
•use to monitor actual amount of o2 delivered
• placed in inspiratory limb
• particularly used in closed circuit.
6. Airway pressure monitoring :
• it is placed in all modern machine, should be less than 20 to 25 cm of h20
• low pressure indicates disconnection
• high pressure indicates bronchospasm.

33. 8. Apnea monitoring :
It is cessation of respiration for more than 10s
In intubated patient :
1. Capnography
2. Airway pressure monitoring
In non intubated patient :
1. Airflow at Nostril.
2. Chest movement
For both
Pulse oximeter

34. Temperature.
 It is used to monitor intraoperative hypothermia.
 It is used in cardiac cases, pediatric cases, patient with burns and febrile.
 Most accurate is core temperature.
Sites :
1. Esophagus
2. Pulmonary artery
3. Nasopharynx
4. Tympanic membrane

35. Hypothermia : It is core temperature less than 35°c
Reasons --- 1. Cool room temperature
2. Heat loss ( vasodilators drugs)
3. Cold iv fluids
• mild --- 28 to 35°c.
• moderate --- 21 to 27°c
• severe ---- < 20°c

36. Systemic
Effects
Of
Hypothermia
Cardiovascular. Bradycardia, hypotension,
Ventricular arrythmia
Respiratory Respiratory arrest below 23
Cerebral Decrease cerebral metabolic
rate
Blood Increased blood viscosity and
platelet count
Acid base balance Acidosis.
Kidney Decrease urine output

37. Treatment of intraoperative hypothermia
 Warm iv fluids
 Increase room temperature
 Blankets
 Warmers

38. Neuromuscular monitoring...
 It is used In patient with neuromuscular disease like myasthenia gravis
 It is used to monitor the reversal response.
Sites :
1. Adductor pollicis ( ulnar nerve)
2. Orbicularis oculi ( facial nerve)
3. Median nerve
4. Posterior tibial nerve
Technique :
 Singke twitch
 Tetanic stimulation
 Train of four.
 Post tetanic stimulation.

39. Central nervous system...
It is used to monitor the depth of anesthesia.
Clinically signs are :
1. Tachycardia, hypertension
2. Movement response to painful stimuli
3. Perspiration
4. Lacrimation
5. Tachypnea
6. Breath holding
7. Eye movements.

40. Monitors include :
EEG:
 Beta waves indicate light anesthesia
 Delta and theta waves indicates deep anesthesia.
 Used to detect cerebral ischemia.

41. Blood loss monitoring...
It is measured by weighing blood soaked swabs, sponges And estimation of blood
loss in suction bottle.
Rough guide :
1. Fully soaked swab – 20ml of loss
2. Fully soaked sponge – 100 to 120ml
3. A fist of clots – 200 to 300 ml of loss.