Monitoring
Intraanesthesia monitoring
25 years ago was continuous palpation of
the radial pulsations
What is the value?
reason
The electricity of the
heart
What to expect ECG
Essential monitor
function
3-lead system
Lead Selection
Lead II is the same as
standard lead two as
seen in a 12 lead
ECG.
The shape of the ECG
P T
Q
R
S
Normal ECG
ECG interpretation
1. Rate
2. Rhythm
3. Intervals
4. QRS complexes
Arrhythmias
Myocardial ischemia /
infarction
ST depression
(0.1mv)
ST elevation
(0.2mv)
T wave inversion
Myocardial ischemia /
infarction
Bradyarrhythmias
Bradyarrhythmias
Bradyarrhythmias
Bradyarrhythmias : 2nd
degree AVB
Bradyarrhythmias : 2nd
degree AVB
Bradyarrhythmias : 3rd
degree AVB
Tachyarrhythmias :
Premature complexes
Tachyarrhythmias :
Premature complexes
Tachyarrhythmias
Tachyarrhythmias
Tachyarrhythmias
Tachyarrhythmias
Tachyarrhythmias
Asystole
(2) SpO2
Monitoring: (2) SpO2
Value:
SpO2: arterial O2 saturation (oxygenation of
the pt).
HR.
Peripheral perfusion status (loss of
waveform in hypoperfusion states: hypotension
& cold extremeties).
Cardiac status.
monitoring: (2) SpO2
Readings:
Normal person on room air (O2 =
21%) 96%.
Patient under GA (100% O2) = 98-
100%.
It is not accepted below 96% with
cannula.
Indicated in: major surgeries, during deliberate
Clinical monitoring:
Colour: pallor (lips, tongue, nails) = anemia,
shock.
Palpate peripheral pulsations every 10
minutes (Radial A, Dorsalis pedis A, Superficial
temporal A).
Capillary refilling time: compress nail bed
until it is blanched. After release of pressure
refilling should occur within 2 seconds. If 5
seconds = poor peripheral perfusion/circulation.
(C) CVS Hemodynamic Monitoring
Management of oliguria or anuria:
Check that the line is not kinked or
disconnected.
Palpate the urinary bladder (suprapubic
IV fluid challenge.
Diuretics.
CVS Monitors:
ECG.
Blood pressure (NIBP, IBP).
Central Venous Pressure: value:
indicator of:
1) IV volume.
2) RV function.
(E) Temperature Monitoring
Clinical monitoring: ur hands.
Monitors: temperature probe:
nasopharyngeal, esophageal.
AVOID hypothermia < 36oC. Why? &
How?
Especially in pediatrics & geriatrics
(extremes of age).
Why is it necessary to avoid
hypothermia? (complications of
hypothermia):
Cardiac arrhythmias: VT & cardiac arrest.
Myocardial depression.
Coagulopathy.
ect
(E) Temperature Monitoring
How to avoid hypothermia:
Warm IV fluids.
Intermittently switching off air-
conditioning esp. towards the
end of surgery.
Pediatrics: warming blanket.
(F) Monitoring After Extubation &
Recovery
After extubation
Good regular breathing with adequate tidal volume
transmitted to the bag.
No transmission to the bag respiratory obstruction
(
BP: within 20% of baseline.
SpO2: 92%
Breathing: regular, adequate tidal volume.
Muscle power: sustained head elevation for 5
seconds, good hand grip, tongue protrusion.
Level of consciousness: fully conscious = 1)
obeying orders, 2) eye opening, 3) purposeful
movement.
To Summarize:
How do I monitor the patient in OR?
The 4 basic monitors displayed on the
screen:
1) ECG.
2) BP.
3) SpO2.
4) Capnogram (EtCO2).
Normal target values for an adult
under GA:
HR: 60-90 ( 90 = tachycardia. <
60 = bradycardia).
BP: 90/60 140/90. MAP 60
mmHg (cerebral & renal
autoregulation). Diastolic BP 50
mmHg (coronary perfusion
pressure).
SpO2 96% on 100% O2.
EtCO2 = 30-35 mmHg.
LISTEN
Listen to the monitor the whole
time:
To the pulse oximeter tone to identify: 1-
Heart rate 2- O2 saturation from the
tone (pitch) of pulse oximeter.
To the sound of the ventilator, to any
abnormal sounds, any alarms.
RULE: NO silent monitors. ALWAYS
keep the HR sound on. If ur monitor is
silent (sound is not working) u have to
look at your monitor the WHOLE time.
LK
Every 5 minutes to note the new
BP reading.
If there is any change in the tone
of the pulse oximeter.
If there is any irregularity in
heart rate & during the use of
diathermy.
Clinical Check / 10
1) Chest inflation.
minutes
2) Ventilator bellows: descend and return to
become fully inflated.
3) Airway pressure.
4) Palpate peripheral pulsations (radial A, or
dorsalis pedis A, or superficial temporal A):
For pulse volume.
During the use of cautery.
In doubt of ECG rhythm (arrythmias).
In case monitor or ECG disconnected.
5) Pt colour (nails): cyanosis, pallor.
6) Vaporizer:
a) Check concentration opened.
b) Level of the volatile agent (if needs to be filled).