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Standards of monitoring for anaesthesia (college docs) (Clinical…
Standards of monitoring for anaesthesia (college docs)
General info
Monitoring is essential (use clinical judgement to determine how long for post anaesthesia)
Healthcare facility responsible for provision, protocols and maintenance
Tailor to individual patient
Must have visual and audible alarms
Clinical monitoring by anaesthetist
Must be separate person to proceduralist
Anaesthetist (or similar) present from commencement to completion - temporarily delegate observation to appropriately qualified person if you must leave
Handover at end as per college document
Anaesthetist should ensure appropriate monitoring equipment available (As per PS1 and PS55)
Clinical monitoring should include:
Circulation: pulse and BP
Ventilation by direct and indirect means
Oxygenation: pulse Ox and adequate lighting to assess patient colour
Monitoroing equipment
Monitoring should be available and appropriately used (alarm enabled, regular recordings documented)
Must be used
Oxygen analyser: warn low fi02, must be used if breathing system is used
Breathing system disconnection/failure alarm if ventilator in use
Pulse ox must be used for sedation and GA
CO2 monitor if GA
NIBP with range of cuff sizes
Volatile concentration monitor if GA and volatile
Must be available
ECG must be available
IABP should be available
Temperature monitor
Neuromuscular function monitor
Monitor of anaesthetic function on brain (BIS)
Others as indicated by situations e.g. CVP, TOE, cardiac output monitor, resp mechanics monitor
Stethoscope, sphygmomanometer
Regional and local anaesthesia
During establishment of major regional anaesthesia and for at least 30mins post or until stable, then dependent on type of regional
Must BP, RR, conscious state
Available: ECG, pulse ox
Resources
PS18: Recommendations on monitoring during anaesthesia
PS3: Guidelines for management of major regional anaesthesia
PS19: Recommendations on monitored care by an anaesthetist
PS55: Recommendations on minimum facilities for safe administration of anaesthesia in operating suites and other anaesthetizing locations