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PERIOPERATIVE MONITORING

DR.M.A.Q MIRZA

[ASSISTANT PROFESSOR

,SHSMCH]

Department of Anaesthesiology

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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.

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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.

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R

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 functioningcorrectly before induction of anaesthesia.

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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]

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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 appliedcontinuously until the patient has recovered fully from

anaesthesia.

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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.Capnograph3.Nerve stimulator

4.Means of measuring the patients temperature.

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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.

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If the patient is unwell before surgery or if major

surgery is planned, additional monitoring should be

applied.

Guidelines on what conditions or surgery shouldprompt 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

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OPERATIONS ON:

A.Chest: Pulmonary capillary wedge

pressure[PCWP]

B. Central nervous system:Cardiac output:

Thermo dilation tech

Dye dilation tech

Trans oesophagealEchocardiography [TEE]

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C.Cardiovascular system:

Blood loss measurement

Trans Esophageal Echocardiography [TEE]

Clinically significant coexisting diseaseo Urine output

o Temperature

o Blood gas analysis

o Serum electrolyte concentration

o Haemoglobin concentration

o Coagulation status

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An automated oscillometer.

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Standard anaesthetic monitoring screen.

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Pulse oxymeter probe on a

child

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]

An automated oscillometer

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VENTILATOR

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FINGER PULSE OXIMETER

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ADULT PROBE

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TRANSESOPHAGEAL

ECHOCARDIOGRAPHYMACHINE

https://www.google.com.bd/search?q=transesophageal+echocardiography+machine&hl=en&client=firefox-a&hs=UqC&rls=org.mozilla:en-US:official&tbm=isch&biw=1280&bih=921&gs_l=img.3...114251.117195.0.117648.8.8.0.0.0.0.165.745.7j1.8.0...0.0...1c.1.nTLhPbjLDyw&nfpr=&spell=1&sa=X&ei=8F5mUfzXIsO4rgfglYHADg&ved=0CCkQvwUhttps://www.google.com.bd/search?q=transesophageal+echocardiography+machine&hl=en&client=firefox-a&hs=UqC&rls=org.mozilla:en-US:official&tbm=isch&biw=1280&bih=921&gs_l=img.3...114251.117195.0.117648.8.8.0.0.0.0.165.745.7j1.8.0...0.0...1c.1.nTLhPbjLDyw&nfpr=&spell=1&sa=X&ei=8F5mUfzXIsO4rgfglYHADg&ved=0CCkQvwUhttps://www.google.com.bd/search?q=transesophageal+echocardiography+machine&hl=en&client=firefox-a&hs=UqC&rls=org.mozilla:en-US:official&tbm=isch&biw=1280&bih=921&gs_l=img.3...114251.117195.0.117648.8.8.0.0.0.0.165.745.7j1.8.0...0.0...1c.1.nTLhPbjLDyw&nfpr=&spell=1&sa=X&ei=8F5mUfzXIsO4rgfglYHADg&ved=0CCkQvwUhttps://www.google.com.bd/search?q=transesophageal+echocardiography+machine&hl=en&client=firefox-a&hs=UqC&rls=org.mozilla:en-US:official&tbm=isch&biw=1280&bih=921&gs_l=img.3...114251.117195.0.117648.8.8.0.0.0.0.165.745.7j1.8.0...0.0...1c.1.nTLhPbjLDyw&nfpr=&spell=1&sa=X&ei=8F5mUfzXIsO4rgfglYHADg&ved=0CCkQvwUhttps://www.google.com.bd/search?q=transesophageal+echocardiography+machine&hl=en&client=firefox-a&hs=UqC&rls=org.mozilla:en-US:official&tbm=isch&biw=1280&bih=921&gs_l=img.3...114251.117195.0.117648.8.8.0.0.0.0.165.745.7j1.8.0...0.0...1c.1.nTLhPbjLDyw&nfpr=&spell=1&sa=X&ei=8F5mUfzXIsO4rgfglYHADg&ved=0CCkQvwUhttps://www.google.com.bd/search?q=transesophageal+echocardiography+machine&hl=en&client=firefox-a&hs=UqC&rls=org.mozilla:en-US:official&tbm=isch&biw=1280&bih=921&gs_l=img.3...114251.117195.0.117648.8.8.0.0.0.0.165.745.7j1.8.0...0.0...1c.1.nTLhPbjLDyw&nfpr=&spell=1&sa=X&ei=8F5mUfzXIsO4rgfglYHADg&ved=0CCkQvwU

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CAPNOGRAPH

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OXYGEN ANALYZER.

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VAPOR ANALYZER

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THERMISTOR

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THERMOCOUPLE