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ANAESTHESIA AND PATIENT MONITORING
Improvingsafetythrough patient monitoring
Patient monitoring in theatres is an important aspect of delivering safe, optimal care and the AAGBI outlines the minimum standards of monitoring and the technologies required – both during surgery and recovery. However, in some procedures, advanced monitoring may also be required. The Clinical Services Journal looks at some key technologies designed to improve outcomes.
IThe monitoring of patients’ vital signs – such as heart rate, blood oxygen saturation (SpO2
electrocardiogram (ECG), temperature and blood pressure – is crucial to ensure the wellbeing of patients undergoing surgery, as well as for guiding treatment and care during their perioperative journey.
There is a multitude of technologies required to measure these vital signs and other key parameters – from pulse oximeters and capnography, to fluid optimisation and haemodynamic monitoring devices. This article looks at current guidance, the latest research and key technologies that form part of the theatre team’s armoury, in the pursuit of safer perioperative care.
Guidance
In 2016, guidance was published by the Association of Anaesthetists of Great Britain and Ireland1
which listed the essential
equipment needed to ensure minimum standards of monitoring, whenever a patient is anaesthetised (or sedated). This included nine key recommendations: l The anaesthetist must be present and care for the patient throughout the conduct of an anaesthetic
l Minimum monitoring devices (as defined in the recommendations) must be attached before induction of anaesthesia and their use continued until the patient has recovered from the effects of anaesthesia
l A summary of information provided by all monitoring devices should be recorded on the anaesthetic record
l The anaesthetist must ensure that all anaesthetic equipment, including relevant monitoring equipment, has been checked before use. Alarm limits for all equipment must be set appropriately before use
l If it is absolutely necessary to continue anaesthesia without an essential monitor, the anaesthetist should note the reasons in the anaesthetic record
SEPTEMBER 2018
l Additional monitoring may be necessary as judged appropriate by the anaesthetist
l Minimum monitoring should be used during the transfer of anaesthetised patients
l Provision, maintenance, calibration and renewal of equipment are the responsibilities of the institution in which anaesthesia is delivered. The institution should have processes for taking advice from departments of anaesthesia in matters of equipment procurement and maintenance
l All patient monitoring equipment should be checked before use in accordance with the AAGBI guideline Checking Anaesthetic Equipment 2012.2
Monitoring equipment
According to the AAGBI, the following are considered the minimum monitoring requirements for anaesthesia: pulse oximeter; non-invasive blood pressure; ECG; inspired
and expired oxygen, carbon dioxide, nitrous oxide and volatile anaesthetic agent if used; airway pressure; peripheral nerve stimulator if neuromuscular blocking drugs are used; and temperature for any procedure >30 minute duration. However, the use of depth of anaesthesia monitors (for example processed EEG monitoring) is also recommended when patients are anaesthetised with total intravenous techniques and neuromuscular blocking drugs, to reduce the risk of accidental awareness during general anaesthesia. The AAGBI adds that: “monitoring must continue until the patient has recovered from anaesthesia.” The minimum monitoring for recovery from anaesthesia, according to the guidance, includes: pulse oximeter; non- invasive blood pressure; ECG; and capnography (if the patient has a tracheal tube or supraglottic airway device in situ, or is deeply sedated); and temperature.
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