MONITORING IN ANAESTHESIA

Why?

• Maintain organ function- resp, CVS, kidney

• Maintain volume status

• Detect complications
 objectives
• Understand how various Parameters are
monitored in anaesthesia

• Understand the equipment used in monitoting

patients

• How to identify errorrs during monitoring

 Pulse oximetry
• Non invasive monitor for Cardiorespiratory function

• Measures arterial oxygen saturation of hemoglobin and heart rate

• Parameters Spo2, heart rate,

• Principle;
– Light absorption at 2 different wavelength by Hb depending on the level
of oxygenation.
– Pulsatile component of the light signals as it is transmitted through the
tissues
Errors/ wrong readings
• Bright light
• Shevering/ motion
• Abnormal Hb- carboxyhemoglobin,
methemoglobinemia
• Trcuspid regurgitation (pulsatile veins)
• Arrhthmias
• Vasoconstriction & hypotention
• Nail polish
NB
• It is not reliable if < 70%
• Not measure content of o2 or dissolved o2
• Not affected by anemia or black skin
• Not assess respiratory capacity (ventilation)
• Amplitude of wave gives an indication of the
cardiac volume
 ECG
• Measures the electrical activity of the heart- ECG, HR
• identify arrhythmias, MI, electrolyte imbalance,

Principle
• Detect the electrical activity of the heart generated during
action potential Between 2 electrodes
• Gets the vector sum of the action potentials
Errors
• Wrong placement of electrodes
• Poor contact of the electrodes to the skin
• Electromagnetic interference form other
equipment.
Increased heart rate
• Pain, inadequate depth of anaesthesia, hypovolemia
• Intubation
• Ketamine, ether, pancuronium, atropine

Decreased heart rate

• Vagal stimulation (occulocardiac reflex)
• Hypothermia
• Increased intracranial pressure
• beta blocker, halothane

Arrhythmias
• Thoracic surgery, hypoxia, acidosis, hypercarpnia, electrolyte imbalance
• Halothane, adrenaline,
 Blood pressure
Non invasive BP
Manual
• sphyngnomanometer (korotkoff sound), oscillotonometer
• inaccuracies - , wrong size cuff, Motion, Wrong position

Automatic
• Oscillonometry (oscillations due to pulsastions)
• Easy to use, free hands
• Inaccuracies - irregular heart beat, motion, extreme BP

Invasive BP. - Radial, femoral, dosalis pedis, brachial artery

• Direct, continuous monitoring, more accurate, real time
• Close supervision
 Central venous pressure(CVP)
• Central venous catheter inserted into the heart from
subclavian, internal jugular, antecubital veins

• Estimates circulatory function and blood volume. CVP

closely resembles left atrial pressure and thus LV (except in heart disease)

• has to be correlated to the clinical findings

• Increased - heart failiure, tension pneumothorax,

tamponade
• Decreased – hypovolemia
 Gas analysis
• Oxygen, carbon dioxide, volatile agents
• Breath to breath analysis
• Adequacy of ventilation
• Interuption in breathing circuit
• Some disease states
 capnography
Technique
• Infrared absorption spectrometry
• Photo acoustic
• Raman scattering
• Mass spectometry
Errors
• Resp failiure
• Increased v/Q mismatch
 Oxygen
Technique
• Galvanic analyser
• Polarographic
• paramagnetic
 others
• Inx Hb, RBS, ABGA
• urine output