Summary

In study session I you have learnt

• The anesthetist must directly observe the progress of the surgery and interpret and integrate information collected by various monitoring systems, so the presence of qualified anesthesia personnel in the operating room is essential throughout the conduct of all general anesthetics, regional anesthetics, and monitored anesthesia care.
• 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.
• Assessment of adequate oxygenation ventilation, circulation and temperature during administration of an anesthetic is essential. Other monitoring includes urine output, depth of anesthesia, integrity of anesthesia equipment and level neuromuscular blockade.
• Oxygenation can be assessed clinically looking at skin color and appearance of blood in the surgical field, using monitoring equipment such as pulse oximeter and oxygen analyzer if available.
• The adequacy of ventilation can be evaluated throughout the course of an anesthetic by observation of chest excursion, auscultation of breath sounds, spirometer and capnography.
• Circulation can be evaluated without instruments by observing surgical blood loss, the mucous membrane and capillary refill time and simple palpation of peripheral arterial pulse, using equipment such as blood pressure cuff, stethoscope, and electrocardiogram.
• The commonest site for detecting body temperature is oral, axillary, skin, esophagus, rectum, and bladder.
• Urinary bladder catheterization is the only reliable method of monitoring urinary output. Inadequate urinary output (oliguria) is often arbitrarily defined as urinary output of less than 0.5 mL/kg/h.
• Regular evaluation of the anesthetic machine is essential part of standard monitoring routine. Equipment problems, either as a result of malfunction or human error are the cause of many common anesthetic complications
• Each patient has a unique individual response to surgical stress and administered anesthetics, the anesthetist should monitor the level of anesthesia required for the procedure.
• The neuromuscular blockade can be assessed using peripheral nerve stimulator (most common train of four and tetanus). Clinical signs should be used with a peripheral nerve stimulator to help determine the degree of recovery from neuromuscular blockade (head lift or hand grip).