Monitoring during Anaesthesia

& it’s complication.

 Contents...

1. Introduction
2. What should be monitored
3. Types of monitors
4. Basic monitoring
5. Advance monitoring
6. Temperature monitoring
7. Blood loss monitoring
8. Conclusion.
 Introduction...

Importance of monitoring...
To provide safety in the preoperative period.
To avoid surgical and anesthesia complications.
To prevent from physiological Disturbances.
Wt should be monitored...

Circulation ( cardiovascular)
Ventilation ( respiration)
Oxygenation ( cardioresporation)
Types of monitors...

Basic monitoring.
Advance monitoring.
Basic monitoring...

Pulse rate.
Color Of skin
Blood pressure
Precordial and oesophageal Sthethoscopy.
Signs of sympathetic Over activity
Urine output.
Advance monitoring...

Cardiovascular Blood loss

Advance monitoring.

Respiratory CNS

Temperature
Cardiovascular system..

CVS

Non Invasive.
invasive.

Semi
invasive
 Non – invasive monitoring....

1.ECG...
• detect cardiovascular problems during perioperative period.
• detect arrythmias., ( lead 2 )
• detect ischemia. (V5)
Timings : it should be monitored throughout the surgery until recovery.
Leads : Either 3 leads or 5 leads are used.
Complications :
Patient refusal
Allergy to adhesive tapes.
2. Non invasive blood pressure :
It is used to detect systolic and diastolic pressure automatically at set intervals.
Frequency of measurement :
By default every 5 minutes.
For spinal anesthesia every 3 minutes.
For GA every 5 minutes
For monitored anesthesia care pt it should be monitored for every 10minutes.
Complications in NIBP :
Nerve damage.
Compartmrnt syndrome.

How to Treat intraoperative hypotension and hypertension

1. Intraoperative Hypotension Can be managed with fluids.
2. Etomidate is preferred for pre existing hypotension pt.
3. Hypotension is common in spinal anesthesia
4. Patient with pre existing hypertension , suitable drug should be given prior.
Semi invasive monitoring...

Transoesophageal echo :
It is use to detect the abnormalities at the wall of The heart.
Most commonly used in cardiac surgeries.
It is far from the setup.
Complications :
Damage to teeth, throat, oesophagus
Breathing problems.
Bleeding.
Invasive monitoring..

1. Invasive blood pressure :

It is used in patient for beat to beat monitor .
Accurate monitoring is obtained
It is called gold Standard period
Difference between nibp and ibp will be 8 mmhg
Sites
1. Radial artery
2. Femoral artery
3. Brachial artery
4. Dorsalis pedis artery
How to choose artery :
Allens test
Normal - <7sec
Boderline – 7 to 14s
Risk - more than 15s.
Complication
1. Artery damage
2. Thrombosis, embolization
3. Sepsis
4. Tissue necrosis
Prevention :
Continuous flush with / without heparin.
2. Central venous pressure :
It is direct method of measuring blood pressure through the central veins that is close to
the heart.
Ie junction of superior vena cava and rt atrium.
Sites:
1. Rt internal jugular vein
2. Subclavian
3. Basilic
4. Femoral vein.
Normal value : 3 to 10cm of h20
Children’s : 3 to 6 Cm of h20.
Indications :
1. Open heart surgeries
2. Major surgeries
3. Fluid management in shock
4. Parenteral nutrition
5. As venous access.
6. Aspiration of air embolism.
CVP conditions increasing and decreasing...
Complications :
Air embolism
Thromboembolism
Pneumothorax/ haemothorax
Sepsis
Cardiac perfusion
Trauma to brachial plexus, carotid artery, and airway during insertion.
Sepsis ( late complication)
Prevention :
Sterile techniques
Avoid ointments
Disinfect cathether hub
Avoid difficult Cathetherization
Dont change cathether route often
Remove no more usage
Prefer subclavian.
3 . Pulmonary artery catheterization :
It is an invasive method by inserting a cathether to the vessels between heart and lung to detect the blood clots and
other cvs prblms.
It is AKA swan-gazz cathertization.
Indications :
Pulmonary hypertension
Assesement in shock
Pericardial tamponade
Measure cardiac output ; RA pressure ; LA pressure.
Complications :
Rupture to pulmonary artery
ThrombOsis
Bleeding.
Pneumothorax.
Respiratory system...

1. Pulse oximeter
2. Capnography
3. ABG
4. Lung volumes
5. Oxygen analysers
6. Airway pressure monitoring
7. Apnea monitoring.
 Pulse oximeter

1. Pulse oximeter :
Indication :
To measure oxygen saturation in blood.
To detect intraop and post op hypoxia
Normal – 97 to 100%
Errors:
1. Carboxyhaemoglobinenia
2. Methhemoglobinemia
3. Anemia
4. Hypovolemia and vasoconstriction
5. Vasodilation
6. Nail polish
7. Shivering
8. Dyes.
PRINCIPLE:

Pulse oxymeter works on the principle of BEER-

LAMBERT law ,which states that different solvents
absorb infrared at different wave lengths.
A pulse oxymeter probe emits two lights of
different wavelengths.(Red-660nm& infrared -
940nm).
Oxyhemoglobin absorbs more infrared light.
Deoxyhemoglobin absorbs more red light.
Co oximeter

Co oximeter :
It is special type of oximeter use to detect spo2 between normal and abnormal hemoglobin. such as carboxyhemoglobinemia and methemoglobinemia
Carboxyhemoglobinemia -- spC0
Methmoglobenemia – spMet
Normal values – Spc0 – less than 9%
Spmet – 0-3%

Complication :
1. False reading
2. Pressure sores / burns.
3. Burns and shock can occur due to high voltage.

4.

Sites:
Finger nail bed, toe nail, ear lobule, tip of nose.
Capnography

2 . Capnography :
It is used to monitor the partial pressure of co2 during anesthesia.
Normal value : 32 to 42 mmhg.

Uses:
1. It is used to confirm tube position
2. To control level of hypocapnia and hyperventilation in neurosurgery.
Complications

No much complication is reported

Alarm fatigue can occur, even in slight
changes
Physical accidents can occur
Tube disconnection may occur bcoz of this
this may lead to several issues like
Changes in waveform :
Blood gas analysis :

3. Blood gas analysis :

Blood gas analysis is used to detect the oxygenation , acid base balance and ventilation during
perioperative period.
Sites : radial ; brachial ; femoral artery
Normal values : ph - 7.38 -7. 42
Po2 – 96- 98 mmhg
Pco2 – 35- 45 mmhg
Things to be seen in abg:
Oxygenation : pa02, So2
Ventilation : Pco2
Acid base balance : ph, Hco3
Lung volume – spirometer

It is one of the common pulmonary function test

It is used to diagnose and monitor certain lung conditions by
measuring how much air you can breathe out in the one
forced breath
Complications
You may feel dizzy after a moment
Heavy blow can lead to cough
May cause infection
Oxygen analysers

It is used to measure the amount of 02 delivered to the

patient
It is located at the inspiratory limb or circuit or inbuild in
modern anesthesia machine
particularly used in closed circuit.
Complications :
If it is not embedded in in anesthesia machine it may lead
to life threatening conditions
Machine leak cannot be detected
Airway pressure monitoring :

It is used to measure the patient airflow, volume and it’s

pressure
It is manually set up in the monitors
Normal range : 20 – 25 CM of h20
Complications :
Correct ratio of pressure cannot be detected
Increase in airway pressure indicates – obstruction,
bronchospasm
Decrease in airway pressure indicates – disconnection, leaks
Apnea monitoring

8. Apnea monitoring :
It is cessation of respiration for more than 10s
It has to be monitored in both intubated and non intubated patient
In intubated patient :
It can be measured using
1. Capnography
2. Airway pressure monitoring
In non intubated patient :
It can be measured using
1. Airflow at Nostril.
2. Chest movement
For both
Pulse oximeter
Monitoring the airflow at nostril :
It can be measured by the use of acoustic probe attached in
nasal cavity, encasing pt head and neck tightly or using non
invasive capnography
Detection of chest movements:
They can be measured using
Impedence plethysmography
Transthoracic impedance pulmonometry
 IMPEDENDE PLETHYSMOGRAPHY

It is a method of evaluating pulmonary ventilation by chest and

abdomibal movement
Thorax is encircled by ealstic band containing conductor coil
and movement detected by changes in impedence
Complications :
No much major complications found.
Minor like
Dizziness
Light headedness
Anxiety
TRANSTHORACIC IMPEDENCE PULMONOMETERY

It is another advanced method of ECG were electric

current is passed through the leads which detects the
transthoracic electric impedence that is further converted
to respiratory rate with q sensor present in that
Complications :
Not much is found
Sometimes electric burns can occur
Temperature.

It is used to monitor intraoperative hypothermia.

It is used in cardiac cases, pediatric cases, patient with burns and febrile.
Most accurate is core temperature.
Sites :
1. Esophagus
2. Pulmonary artery
3. Nasopharynx
4. Tympanic membrane
Hypothermia : It is core temperature less than 35°c
Reasons --- 1. Cool room temperature
2. Heat loss ( vasodilators drugs)

3. Cold iv fluids
• mild --- 28 to 35°c.
• moderate --- 21 to 27°c
• severe ---- < 20°c
Systemic
Effects
Of
Hypothermia
Treatment of intraoperative hypothermia
Warm iv fluids
Increase room temperature
Blankets
Warmers
Neuromuscular monitoring...

It is used In patient with neuromuscular disease like myasthenia gravis

It is used to monitor the reversal response.
Sites :
1. Adductor pollicis ( ulnar nerve)
2. Orbicularis oculi ( facial nerve)
3. Median nerve
4. Posterior tibial nerve
Technique :
Singke twitch
Tetanic stimulation
Train of four.
Post tetanic stimulation.
Central nervous system...

It is used to monitor the depth of anesthesia.

Clinically signs are :
1. Tachycardia, hypertension
2. Movement response to painful stimuli
3. Perspiration
4. Lacrimation
5. Tachypnea
6. Breath holding
7. Eye movements.
Monitors include :
EEG:
Beta waves indicate light anesthesia
Delta and theta waves indicates deep anesthesia.
Used to detect cerebral ischemia.
Blood loss monitoring...

It is measured by weighing blood soaked swabs, sponges And estimation of blood loss in
suction bottle.
Rough guide :
1. Fully soaked swab – 20ml of loss
2. Fully soaked sponge – 100 to 120ml
3. A fist of clots – 200 to 300 ml of loss.