The Presence Anesthetist
The Presence Anesthetist
The role of anesthetist in creating appropriate conditions for the performance of a surgical procedure is complex and requires not only providing the patient insensibility to pain but also maintaining homeostasis, the ability of the organism maintain relatively stable internal conditions (Table 2.1). To this end, the anesthetist must directly observe the progress of the surgery and interpret and integrate information collected by various monitoring systems. Acting on this information, the anesthetist assesses the requirements of the situation on a moment to moment basis and institute appropriate action as needed.
The selection of monitoring devices is based on the anesthetist's need to know specific information about the patient and his/her ability to apply and interpret the information gained from the monitor. The most important monitoring element is the anesthetist's ability to evaluate the patient without the use of instruments. Information is collected by the continuous observation and periodic examination of the patient by inspection, palpation, and auscultation. This rapid evaluation of the patient and the anesthesia system is the simplest and most reliable assurance of patient safety. Although monitoring devices are valuable and provide much information, some of which cannot be obtained without the use of sometimes sophisticated technology, expense, and they are subjected to failure and malfunction.
When the reliability of an instrument comes in to question because the information provided appears incompatible with the clinical situation, the anesthetist often relies on simple and effective monitoring without the use of instruments. An extremely important aspect of anesthetic care is the integration and determination of the validity (true measurement) of the information collected from simple and complex monitoring system.
Table 2.1 Normal Value of Healthy Adult Undergoing Adequate General Anesthesia
| Parameter Measured | Normal Value |
|---|---|
| Blood pressure mm Hg systolic | 90 - 140 |
| Electrocardiogram | Sinus rhythm |
| Heart rate, beats per min | 60-100 |
| End tidal carbon dioxide mm Hg(torr) | 35-45 |
| Arterial oxygen saturation % | 98-100 |
| Temperature ºC | 36.5- 37.5 |
| Urine output ml/kg/hr | >0.5 |
| Skin appearance | Pink, warm and dry |
| Capillary refill | <3sec |
The anesthetist is also responsible for the preparation of an anesthetic record, a portion of the permanent hospital record in which the events of the anesthesia and surgery are reported. Advantages of anesthesia record include continuous monitoring of the patients, continuity of care post operatively, as a reference for future care, for a research purposes and medico legal issue. The anesthetist records the anesthetic technique, monitors employed, drugs and dosages used, air way maintenance (i.e., mask, laryngoscopy, endotracheal tube), and fluids given (i.e., crystalloid, colloid, blood and blood products) as well as events related to surgery (patient position, incision, blood loss) In addition, vital signs and other physiologic data are recorded graphically so that trends can be determined and unfavorable outcomes predicted and averted.