Monitoring

• We monitor to:

  • detect any adverse changes.
  • Patient safety
  • Professional diligence
  • record of the anaesthetic event.
• Inadequate plane of anaesthetic as heart rate and blood pressure will increase. Leading to development of tachycardia and heart arrythmias as sympathetic nervous system is activated.
• Physiological status is added by observing and measuring physiological parameters.
• Level of consciousness is assessed by testing reflex responses that vary according to the depth of anaesthesia.
• Tachycardia is caused by pain, light anaesthesia, drugs, hypovolemia/ blood loss.
• Bradycardia is caused by drugs, anaesthetic overdose, surgery that leads to vagal stimulation and impending cardiac arrest.
• pink mucous membranes indicates hypercapnia (excess CO2)
• Pulse is taken from peripheral sites as they are more sensitive in a drop in BP, lost before femoral pulse.
• Pulse sites include:

  • Metacarpal
  • Metatarsal
  • Dorsal pedal
  • Lingual
  • Sub-lingual
• Respiratory is monitor by observing chest wall movement + reservoir bag, mm colour and stethoscope to auscultate.
• Apnea is caused by a ET tube blockage, no oxygen to system or too much volatile agent.
• Hypothermia is caused by:

  • Alpha-2 drugs, as affect vasodilation.
  • blood loss
  • muscle relaxant
  • cold FGF
  • Skin prep- clipped hair ect.
• Light anaesthesia plane- parameters:

  Increased Pulse rate

  Increased respiratory rate

  may breath hold

  Increase in blood pressure
• Light anaesthesia plane- reflexes:

  Pupils dilated.

  Eye is central

  Brisk palpebral reflex

  muscle tone present
• Surgical anaesthesia plane- Parameters:

  Respiratory rate is slightly reduced.

  Heart rate and Blood pressure slightly reduced.
• Surgical anaesthesia plane- Reflexes:

  Pupils constricted.

  Eye rolls ventromedial position.

  Palpebral reflex absent.

  jaw tone absent.

  Pedal reflex sluggish/absent.
• Anaesthetic overdose- Parameters:

  Slightly depressed cardiac and respiratory function.

  Decreased pulse rate and blood pressure.

  Failure of respiratory muscle function.

  cyanosis and increased CRT.
• Anaesthetic overdose- Reflexes:

  Pupils dilated

  eyes central

  Palpebral reflex absent.

  Corneal reflex absent.

  Jaw tone absent.

  Pedal reflex absent.