This document discusses the importance of monitoring patients during anesthesia. It states that the primary goal of monitoring is to keep patients as safe as possible during surgery by evaluating their oxygenation, ventilation, circulation, and temperature throughout the procedure. Proper monitoring can reduce risks such as hypoventilation, equipment malfunctions, and physiological imbalances. The document outlines the American Society of Anesthesiologists' guidelines for standard monitoring, including continuous evaluation of respiration, pulse oximetry, end-tidal carbon dioxide, electrocardiography, blood pressure, temperature, depth of anesthesia, muscle relaxation, and urine output. It emphasizes that while machines are helpful aids, the most important monitor is the presence of qualified anesthesia personnel.

2.  Primary goal of monitoring is to keep the
patient as safe as possible in the
perioperative period.
 Anesthetic agents – cardiopulmonary
depressants
 Anaesthesia and surgery are serious
invasion on the physiological stability of
the human body.
 Proper monitoring can reduce the risks
involved in anaesthesia and surgery.

3. 1. Disconnection
2. Hypoventilation
3. Esophageal intubation
4. Bronchial intubation
5. Circuit hypoxia
6. Anesthetic overdose
7. Hypovolemia
8. Pneumothorax
9. Air Embolism
10.Hyperthermia/hypoth
ermia
11. Acid-base
imbalance
12. Cardiac
dysrhythmias

4. 1. MEASURE(physiological parameters & their
measurement such as BP ,HR hourly urine
output)
2. OBSERVE (e.g. observation of
pupils,respiratory pattern)
3. PLANNING(e.g. planning induction of
anesthesia or planning extubation)
4. DIAGNOSIS(e.g. unilateral air entry may mean
endobronchial intubation)
5. Planning to GET OUT OF TROUBLE (e.g.
differential diagnosis and response algorithm
formulation)

5. 1. Visual monitoring of
respiration and overall
clinical appearance
2. Finger on pulse
3. Blood
pressure(sometimes)

6.  Not just a famous neurosurgeon
…but the father of anesthesia
monitoring
 Invented and popularized the
anesthetic chart
 Recorded both BP and HR
 Emphasized the relationship
between vital signs and
neurosurgical events
 ( increased intracranial
pressure leads to hypertension
and bradycardia )

7.  Standardized basic monitoring requirements
(guidelines) from the
 ASA(American Society of
Anesthesiologists),october 2015
 Many integrated monitors available
 Many special purpose monitors available

10.  Qualified anesthesia personnel shall be
present in the room throughout the conduct
of all general anesthetics, regional
anesthetics and monitored anesthesia care.
 OBJECTIVE-because of the rapid changes
in patient status during anaesthesia.
 To ensure quality patient care.

11. During all anesthetics, the patient’s
1. oxygenation,
2. ventilation,
3. circulation and
4. temperature shall be continually
evaluated.

12.  OBJECTIVE-to ensure adequate o2 conc.in
inspired gas and blood during all
anaesthetics
 METHODS-
1. Inspired gas-o2 analyzer with an alarm
2. Blood oxygenation-pulse oximetry with
audible alarm
3. Adequate illumination to assess the colour

16.  OBEJECTIVE-to ensure adequate ventilation of
patient during all anaesthetics
 METHODS-
1. Qualitative signs-chest excursion,observation of
reserviour bag,auscultaion of breath sounds
2. End tidal CO2-capnography/capnometry.
3. General anaesthesia-detection of disconnection
with audible alarm
4. Regional anaesthesia/sedation-clinical signs,ET
CO2

19.  OBJECTIVE-adequate o2 delivery to vital organs
must be maintained during anaesthesia.
 Adequate BP is assumed to predict adequate
organ blood flow
 METHODS-
1. ECG-detect arrythmias,myocardial
ishchemia,conduction
abnoramlities,dyselectrolytemia
2. BP/HR- atleast every 5min.
3. Clinical methods-palpation of pulse,auscultaion of
heart sounds.

21.  HYPOTHERMIA-
1. Delayed drug
metabolism
2. Increased blood
glucose
3. Vasoconstriction
4. Impaired coagulation
5. Surgical infection
 HYPERTHERMIA
1. Tachycardia
2. Vasodilation
3. Neurological injury
 SITES-
1. tympanic membrane
2. Nasopharynx
3. Esophagus
4. Bladder,rectum
5. Skin,Axillary

22.  OBJECTIVE- to ensure adequate depth of
anaesthesia to prevent intraoperative
awareness
 METHODS
 EEG-adequacy of cerebral oxygenation
1. Alpha waves-Resting adults with eyes closed
2. Beta waves-concentrating individuals
3. Delta waves-deep sleep,anaesthesia
4. Theta waves-light sleep,conscious sedation

24.  OBJECTIVE-because of variation in patient
sensitivity to neuromuscular blocking agents
and ensure adequate paralysis
 Also indicates adequacy of recovery/reversal
from neuromuscular blockade.
 Clinical signs-sustained head
lift>5secs,forceful hand grip,sustained eye
opening>5secs.

27.  OBJECTIVE-urine output is a reflection of
kidney perfusion and function and an
indicator of renal,cardiovascular and fluid
volume status
 Normal urine output- 1-2ml/kg/hour
 Oliguria : <0.5ml/kg/hour
 Indications-lengthy Sx,intraop diuretic
use,CCF,Renal failure,shock.

28.  Mechanical and electronic monitors are best
aid to vigilance and monitoring.
 But the only indispensable monitor is the
presence, at all times, of a physician or an
assistant, under the immediate
supervision of an anesthesiologist, with
appropriate training and experience.