PERIOPERATIVE MONITORING

DR.M.A.Q MIRZA
[ASSISTANT PROFESSOR
,SHSMCH]

Department of Anaesthesiology

Monitors provide information on patient physiology in

the perioperative period. One of the responsibilities of
an Anaesthesiologist is to act as a guardian of the
anaesthetised patient during surgery.
In fact Vigilance is the motto of the Anaesthesiologist.
Increase in the numbers of monitors in recent years
has increased the amount and quality of information.

GENERAL GUIDELINES FOR

MONITORING DURING ANAESTHESIA:
A. INDUCTION OF ANAESTHESIA:
Oxygen analyzer.
Pulse oximeter.{Spo2 measurement}
Non invasive arterial pressure monitor.
ECG.
Capnograph - EtCo2 measurement.

The following must be available:

Nerve stimulator if muscle relaxants are used.
Means of measuring the patients temperature

1.Thermistor

2.Thermocouple
Monitors should be applied to the awake patient and
readings taken to ensure that they are functioning
correctly before induction of anaesthesia.

B.MAINTENANCE OF ANAESTHESIA
The following must be applied to the patient
Oxygen analyzer.
Pulse oximeter-{Spo2 measurement}
Non invasive arterial pressure monitor.
ECG.
Capnograph
Vapor analyzer[If anaesthetic vapor's are used]

The following must also be available:

Nerve stimulator if muscle relaxants are used.
Means of measuring the patients temperature.

C.RECOVERY

FROM
ANAESTHESIA:

A high standard of monitoring should be applied

continuously until the patient has recovered fully from
anaesthesia.

Direct clinical observation should be supplemented

by :
1.Pulse oximeter
2.Non invasive arterial pressure monitor
The following must also be available:
1.ECG
2.Capnograph
3.Nerve stimulator
4.Means of measuring the patients temperature.

If the recovery room is not immediately adjacent to the

O.T. or if the patients condition is poor, equipment's
should be available so that the above mentioned
standards are applied during transfer of the patient.
ADDITIONAL MONITORING:
The above standards apply to the healthy patients
undergoing minor surgery.

If the patient is unwell before surgery or if major

surgery is planned, additional monitoring should be
applied.
Guidelines on what conditions or surgery should
prompt the use of each monitor:
INDICATIONS
MONITORS
1.Operative duration >3 hours
Direct arterial
pressure measurement
2.Blood loss>10% of
central venous pressure
blood volume

OPERATIONS ON:
A.Chest:
Pulmonary capillary wedge
pressure[PCWP]
B. Central nervous system: Cardiac output:
Thermo dilation tech
Dye dilation tech
Trans oesophageal
Echocardiography [TEE]

C.Cardiovascular system:
Blood loss measurement
Trans Esophageal Echocardiography [TEE]

Clinically significant coexisting disease

o
o
o
o
o
o

Urine output
Temperature
Blood gas analysis
Serum electrolyte concentration
Haemoglobin concentration
Coagulation status

An automated oscillometer.

Standard anaesthetic monitoring screen.

Pulse oxymeter probe on a

child

An automated oscillometer

VENTILATOR

FINGER PULSE OXIMETER

ADULT PROBE

TRANSESOPHAGEAL
ECHOCARDIOGRAPHY MACHINE

CAPNOGRAPH

OXYGEN ANALYZER.

VAPOR ANALYZER

THERMISTOR

THERMOCOUPLE