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1. CHAIR PERSON : DR SYED AASIM ALI SIR
(PROFESSOR& HOD)
MODERATOR : DR MAHESWAR REDDY SIR
(ASSISTANT PROFESSOR)
PRESENTOR : DR ANIL KUMAR

2. BEST MONITOR IN OPERATING ROOM -
ANAESTHESIOLOGIST

4. HARVEY CUSHING
 Famous neurosurgeon
 Father of Anaesthesia
Monitoring

5. STANDARDS FOR BASIC ANAESTHETIC MONITORING HAVE
BEEN ESTABLISHED BY THE
ASAAMERICAN SOCIETY OF
ANAESTHESIOLOGIST
CAS CANDIAN ANAESTHESIOLOGISTS SOCIETY
OTHER NATIONAL SOCIETIES

6. WHAT SHOULD BE MONITORED
 Circulation
 Ventilation
 Oxygenation
 Maintain adequate tissue perfusion with oxygenated
blood

7. MINIMUM MONITORING STANDARDS
Standard –I
Requries Qualified peronnel
Standard – II
Specifically mandates the following
1. Use of an inspired oxygen analyzer
2. Quantitative assessment of blood oxygenation
3. Continuously ensuring adequacy of ventilation
4. Quantitative monitoring of tidal volume and capnograpy
5. Qualitative clinical signs
6. Ensure correct placement of ET tube
7. The adequacy of circulation monitored by continuous
display of ECG ,BP, HR at least every 5 minutes

8. BASIC MONITORING
 CARDIAC- BLOOD PRESSURE,HEART RATE,ECG
 RESPIRATORY-PULSE OXIMETER,CAPNOGRAM
 TEMPERATURE
 URINE OUTPUT
 AUSCULTATION

9.  How to monitor circulation?
 palpation,auscultation
 arrhythmia,ECG
 blood pressure

10. How to montior oxygenation?
 blood gas analysis
 pulse oximetry
 oxy hemoglobin saturation
 hemoximetry –
oxyhemoglobin,methemoglobin,carboxyhemoglobin

11.  How to monitor ventilation?
 Arterial blood gases
 Capnography – EtCO2,respiratory rate
 Respirometry – tidal volume,minute volume

12. PULSE OXIMETRY

13. PULSE OXIMETRY
 PULSE OXMETRY measures pulse rate,estmates SPO2 of
Hb
 SAO2 is a good reflection of the extent of hypoxia and the
change in status of arterial oxygenation
 Pulse oximetry based on the following measures
1.Color of Blood is a function of oxygen saturation
2.Change in color results from optical properties of Hb and
its interaction with oxygen
3.The ratio of oxyheamoglobin and heamoglobin can be
determineded by absorption spectrometry
Pulse Oximetry combines technology of plethysmography
and spectrophotography

14.  Plethysmograpy produces a pulse trace that is helpfull
in tracking circulation
 Spectrophotometry based on BEER LAMBERT Law
 BEER LAMBERT Law – at a constant light intensity
and heamoglobin content , the intensity of light
transmitted through a tissue is a logarithmic function
of oxygen saturation of heamoglobin

15.  Pulse oximetry probe
sites
 finger
 toe
 ear lobe
 nose
 tongue
 cheek
 forehead

16. LIMITATIONS AND DISADVANTAGES
 Poor function with poor perfusion
 Delayed hypoxic event detection
 Inaccuracy with diferent heamoglobins
 Malposition of probe, probe damage
 Skin pigmentation
 Nail polish and coverings
 Pressure on probe

17. BLOOD PRESSURE MONITORING

18. BLOOD PRESSURE
 It is an important indicator of adequacy of circulation
 Systemic blood pressure commonly measured using
extremity encircling cuff or directly by insertng
catheter in to artery
 Blood pressure measured in two methods
1.non invasive
2.invasive

19.  Non invasive blood pressure measurement is simplest
method by palpating the return of arterial pulse while
an occluding cuff is deflated
 Auscultation of Korotkoff sounds permits estimation
of Systolic ,Diastolic blood pressures.
 Korotkoff sounds results from turbulent flow with in
an aretery created by the mechanical deformation
from the blood pressure cuff
 MAP = DBP+ 1/3PP
 Microprocessor controlled oscillotonometers have
replaced ausculatory and palpatory techniques

20. INVASIVE MEASURES OF ARTERAL
BLOOD PRESSURE
 Intra arterial blood pressure monitoring uses fluid
filled tubing to transmit the force of pressure pulse
wave to a pressure transducer that converts the
displacement of a slicon crystal into voltage changes
 The electrical signals are amplified , filtered and
displayed as the arterial blood pressure trace.
 Indications for invasive blood pressure monitoring-
cardiac surgeries, organ transplant surgeries,
hypotensive anaesthesia , surgeries involving extreme
heamodynamic instabilities – pheochromocytoma ,
repeated ABG sampling

21.  Three techniques for
cannulation are common
1.Direct artery puncture,
2.Guide wire assisted
cannulation ( seldinger
technique ),
3.Transfixion –
wthdrawal method

22. COMPLICATIONS OF INVASIVE
ARTERIAL MONITORING
 Heamatoma formation ,
 Thrombosis ,
 Damage to adjacent nerves ,
 Thromoembolism during cannula removal

23. CENTRAL VENOUS PRESSURE
MONITORING
 For introperative vascular access and for assesment of
changes in vascular volume
 Central venous cannulas permits rapid administration of
fluids , insertion of pulmonary artery catheters or Central
venous catheters ,insetion of trans venous electrodes
,central venous pressure monitor and site for observation
and treatment of venous air embolism.
 The right internal jugular vein most common site for
cannulation.
 Central Venous Pressures are essentially equivalent to Right
Atrial Pressures and serve as reflection of right ventricular
preload

25. INSPIRATORY GAS MONITORING
 3 Main oxygen analyzers seen n clinical practise
1. Paramagnetic Oxygen analyzer
2. Galvanic cell Analyzer
3. Polarographic oxygen analyzer

26. EXPIRED GASES MONITORING
 The patient expired gas composed of O2,N2,CO2 and
Anaesthetic gases
 CO2 is usually sample near the endotracheal gas delvery
nterface.
 Capnometry is the measurement and numeric reprentation
of CO2 concentration during inspiration and expiration
 Capnogram is continue concentration -time display of the
CO2 concentration sampled at a patient airway during
ventilation
 Capnography is continue monitoring of patients
capnogram.
 EtCO2 is best reflection of patient alveoli co2
concentration

27. capnogram

28.  Increases in EtCO2
Hyperthermia,
Sepsis,
malignant
hyperthermia,
shivering,
hyperthyroidism,
hypoventilation,
rereathing
 Decreases in EtCO2
Hypothermia
Hypothyroidism,
Hypoperusion,
Hyperventilation

30. TEMPERATURE MONITORING
 Heat is produced as conseqence of cellular metaolism
 In adults thermoregulation involves the control of
basal metabolic rate,muscular activity, vascular tone
and hormones activation
 Thermoregulatory system maintains core body
temperature approx 370c
 Thermoregulation information process in 3 phases
Afferent Thermal Sensing ,Central regulation ,
Efferent Responses

31.  Rationale for use
1. detect/ prevent hypothermia
2. Monitor deliberate hypothermia
3. Adjunct to diagnosing malignant hperthermia
 sites: esophageal
nasopharyngeal
axillary
rectal

32. Hypothermia complications
 Delayed recovery ,
 Risk for post operative myocardial ischemia

33. Urinary out put
 Urinary bladdercatheterization is most reliable method
 Catheterization is routine in prolonged surgeries like-
cardiac surgery ,
craniotomy ,
adominal surgeries
renal vascular surgeries ,
procedures in which large fluid shift expected
 0.5 – 1.0 ml/kg/hour is normal urinary out put
 Urinary catheter should be removed as soon as to avoid the
risk of urinary tract infections

34. Blood loss estimation
 ALB =EBV[Hct (i) – Hct (f) ]/Hct (i)
ALB – Allowable Blood loss
EBV – Estmated Blood Volume
Hct (i) – Heamatocrit initial
Hct (f) – Heamatocrit final
 Estimated blood volume =weight x Average blood
volume

35. Blood loss calculating in OT
 Weight of blood soaked swabs substract the dry swab
weight [ 1ml of blood nearly equal to 1mg ]
 Blood in Suction apparatus with out irrigation fluid
 Blood on the drapes
 Blood pooled beneath the patient and on floor