Intraoperative Monitoring

1. INTRA OPERATIVE MONITORING
DR RAKESH SADHU
HOD
DEPTT OF ANAESTHESIOLOGY & ICU
MMMC&H, SOLAN

2. ETERNAL VIGILANCE IS THE PRICE OF SAFETY

3. Intra Operative Monitoring
• Cardiovascular System Monitoring
• Respiratory System Monitoring
• Neurological Monitoring
• Miscellaneous Monitoring

4. Intra operative monitoring
• Non invasive –
• NIBP
• ECG
• Pulse Oximetry
• Minimally invasive –
• Temp probe
• Invasive –
• CVP
• PAP/ PCWP/ CO
• ABP

5. Basic Requirements
• Given by ASA –
– ASA Standards I
– ASA Standards II

6. ASA Standards I
• Presence of qualified anaesth personnel in
OT throughout conduct of all –
• GA
• RA
• MAC
• Why ???
• Because of rapid changes in pt status ↓ anesth

7. ASA Standards II
• Continual evaluation of –
– Oxygenation
– Ventilation
– Circulation
– Temp

8. Oxygenation
• Objective is to ensure adequate O2 conc in
inspired gas & blood
• Inspired Gas – O2 conc in pt breathing sys
measured by O2 analyzer with low O2 conc
alarm
• Blood Oxygenation – Quantitative methods
like pulse oximetry

9. Ventilation
• Objective is to ensure adequate ventilation
of pt
• How ???
– Continual evaluation of adequacy of ventilation
by qualitative signs such as –
• Chest excursion
• Observation of reservoir breathing bag
• Auscultation of breath sounds
• Presence of CO2 in expired gas

10. Ventilation contd…
• When ETT/ LMA used –
– Ensure correct placement – Cli assess/ EtCO2
– Capnography/ Capnometry/ Mass Spectroscopy
• When using mech ventilator, continuous
monitoring for disconnection  audible alarm
• During RA & MAC, evaluate adequacy of
ventilation at least by continual observation
of qualitative cli signs

11. Circulation
• Objective is to ensure satisf circulatory fn of pt
• How ???
– Continuous ECG
– Arterial BP & HR, at least every 5 mins
– Continual evaluation by at least one of –
• Palpation of pulse
• Auscultation of heart sounds
• Monitoring of a tracing of intra arterial pressure
• USG peripheral pulse monitoring
• Pulse plethysmography or Oximetry

12. Body Temperature
• Objective is to help in maintenance of
appropriate body temp
• Esp important when cli signi swings in body
temp are intended, anticipated or suspected
• How ???
– Surface temp probe
– Touching pt

13. CVS Monitoring
• Arterial BP
– NIBP
• Palpatory, Doppler, Auscultatory, Oscillometry,
Plethysmography (FinAPres), Arterial Tonometry
– IBP (Sites ???)
• ECG
• CVC – Rt IJV & Seldinger Tech preferred
• PAC
• CO
• TEE

14. Respiratory System Monitoring
• Precordial & Esophageal Stethoscope
• Pulse Oximetry
• EtCO2 Analysis
• Pt CO2/ Pt O2
• Anesthetic Gas Analysis with Hypoxia
Alarm

15. Neurological (CNS) Monitoring
• EEG
• BIS
• Evoked Potentials –
• Visual
• Auditory
• SSEP
• MEP

16. Misc Monitoring
• Temp
• Urinary Output
• Peripheral Nerve Stimulation

17. • MONITORING SHOULD NOT BE
DENIED ON THE BASIS OF COST

18. THANK YOU