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ANAESTHETIC AND

CRITICAL CARE
MONITORING
Introduction
These days , we have reasonable number of
monitoring devices ranging from some
mandatory ones like pulse oximeter,
capnograph to others like thermometers. While
these devices are important, they should not
take away or replace critical devices of our
bodies ,that is our five senses.
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What are the aims of monitoring ?


(a)It will provide information that improves the
safety of anaesthesia.
(b)Monitoring provide a means to assess the
physiological functions like blood pressure ,
pulse etc.
(c)One can detect early any adverse effects
and once that is done , correction can be
carried out.

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The following monitorings although not exhaustive


has been carried on the following body systems:(i) Central nervous system
(a) electroencephalogram (EEG)
The patterns are known to be influenced by
Inhalational anaesthetics.
Injected drugs.
Arterial blood gases (ABGS)
Body temperature
Blood pressure (BP)
If normal EEG are observed , it means the patient is
receiving adequate oxygen O2 for EEG evaluate adequacy
of O2.
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(b) A sensory evoked potential


This is an electrophysiological response to pain
and could be from a stimuli like somatosensory ,
light (visual) and sound (auditory) .
Evoked potentials are also influenced by: The volatile agents
ABGS
Body temperature
B.P etc.
Evoked potential evaluate if the neural pathways
are intact.
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Cardiovascular system (CVS)


The monitoring which can be done :
Blood pressure measurements.
Electrocardiogram (ECG)
Central venous pressure (CVP)
Two dimensional transoesophageal
echocardiograph.
Flow measurements.

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Blood pressure measurement


Could be non-invasive or invasive.
Non-invasive entails use of ordinary
BP machines.
- The cuff size need not be
emphasized for it should have a
diameter of about 40% of arm
circumference.
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Invasive method entails canulating one of the


peripheral arteries to get a continuous BP
reading.
Key features to be observed: Undertake Allens Test to check whether
collateral circulation is adequate.
Associated with complication like thromboembolic associated with canula size . Other
complication infection etc .
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Central venous pressure (CVP)


Indications for placement of central venous
catheter :

Measurement of CVP itself.


Rapid infusion of fluids.
Parenteral alimentation.
Long term chemotherapy.
In severe shock
Major surgeries like open heart Renal transplant.
Paediatric surgery.
The normal CVP-3-10 cmH2o . Greater than 20 cmH2o may
imply heart failure or catheter tip in the right ventrical or
pulmonary artery.
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Route of placement of CVP catheter


Basilic vein.
External/internal jugular veins.
Subclavian vein.
Femoral vein.

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Complication of this catheter placement


Thrombophlebitis.
Infection / septicaemia.
Pneumothorax / haemothorax.
Brachial plexus injury.
Air embolism.
Pericardial effusion.

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ECG one can do the following


Detect dysrhythmias
Can detect myocardial ischaemia.
Can pick electrolyte abnormalities.
Heart rate calculation.

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Two dimensional transesophageal


echocardiograph.
This permits observationof : Cardiac ventricular wall motions
Valvular motions.
With the above one can : Pick myocardial ischaemia.
Estimate end-diastolic and end-systolic
volumes (injection fraction).
Can also pick venous air embolism rapidly.
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Pulmonary system monitoring


Arterial blood gas (ABGS).
Pulse oximetry.
Airways pressures.
Capnography.
Transcutaneous gas measurements.

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Capnography
A very good indicator for a successful
intubation for it measures end tidal carbon
dioxide (CO2)
Waveform has five features :Height
Breathing rate.
Rhythm.
Baseline.
Shape.

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Pulse oximetry
Measures arterial oxygen saturation
Non-invasive.
Gives a continuous measurement.

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Transcutaneous gas measurements


Using some transducers , one can measure
gases like O2 , CO2 diffusion through skin.
Evaluate blood flow or adequate O2
administration.

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Renal function
Catheterising and collecting urine can give
* An indication of whether cardiac output
is
adequate.
* Evaluate extracellular fluid volume.

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Temperature measurements
This is also very important for the extremes
may not be tolerated.
One can also pick pathologies like malignant
hyperthermia.

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Records
Both in theatre and critical care units need
not be emphasized.
In theatre usually have anaesthetic charts.

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In conclusion monitoring of patients


and record keeping both in theatre
and critical care areas is very crucial
in the modern day for anaesthesia
practitioners.

Thanks prepared by Dr.


Muriithi
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