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Monitoringinanaesthesia
Monitoringinanaesthesia
IN
ANAESTHESIA
INTRODUCTION
Non invasive
ECG
blood pressure -
NIBP
1.ECG
Mandatory monitor to detect :
Arrhythmia – lead II
Ischemia – lead V5
cardiac arrest.
2. NIBP
Measure blood pressure at set intervals
automatically by automated oscillometery.
Sepsis
Tissue necrosis
Fluid overloading
Congestive cardiac failure.
Pulmonary embolism
Cardiac tamponade
Constrictive pericarditis
Pleural effusion
Hemothorax
Complication
Air embolism
Thromboembolism
Cardiac arrhymias
Pneumothorax/haemothorax/chylothorax
Severe arrhymias
Death
RESPIRATORY MONITORING
1. Pulse oximetry
2. Capnography
3. Blood gas analysis
4. Lung volumes
5. Oxygen analysers
6. Airway pressure monitoring
7. Apnea monitoring
1. PULSE OXIMETRY
Probe is applied at :
finger
nail bed,
toe nail bed ,
ear lobule,
tip of nose
Uses : detection of hypoxia intra/post operative
> ERRORS
Carboxyhaemoglobinemia
Methhemoglobinemia
Anemia
Nail polish
Shivering
Skin pigmentation
Dyes
2. CAPNOGRAPHY
It is the continuous measurement of end tidal
(expired) carbon dioxide (ETCO2) and its
waveform.
Normal: 32 to 42 mmHg (3 to 4 mmHg less than
arterial pCO2 which is 35 to 45 mmHg).
Principle : infrared light absorbed by carbon
dioxide
Important and sensitive monitoring
3. BLOOD GAS ANALYSIS
Precaution
Glass syringe is preferred for sampling
Important in
Thoracic surgery
Hypothermia
Hypotensive anaesthesia
NORMAL VALUES ON ROOM AIR
pH - 7.38 to 7.42
Base deficit -3 to + 3
CONT
Mixed venous oxygen in the best indicator of
cardiac output i.e., tissue oxygenation
Arterial oxygen is the better indicator of
pulmonary function.
Intubated patients
Capnography - Most sensitive and cost effective to detect apnea
Airway pressure monitor
Pulmonary artery
Nasopharynx
CVS
Bradycardia
Hypotension
Ventricular arrhythmias if temperature is less than 28°C
Respiratory system
Respiratory arrest below 23°C
O2 dissociation curve is shifted to left
Blood
Increased blood viscosity and platelet
count
Acid base balance
Increased solubility of blood gases
Endocrine system
Decreased adrenaline and
nor-adrenaline
Hyperglycemia
> TREATMENT OF LNTRAOPERATIVE
HYPOTHERMIA
Required for :
Myasthenia gravis
Duchenne’s muscular dystrophy
Assess reversal
Ratio 0.7 indicate adequate reversal
Recovery guaranteed at ratio 0.9
Single twitch
Tetanic stimulation
(DBS 3,3 )
CENTRAL NERVOUS SYSTEM
MONITORING
MONITORING DEPTH OF ANAESTHESIA
Clinically :
Signs and symptoms of light anaesthesia are:
Tachycardia.
Hypertension.
Lacrimation.
Perspiration.
Movement response to painful stimuli.
Tachypnea, breath holding, coughing, laryngospasm,
bronchospasm.
Eye movements.
Preserved reflexes
EEG
Patient evoked response
Bispectral index