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Monitoring of unconscious patient Dr Patricia YEO Senior Medical Officer Department of Anaesthesia Operating Services AHNH Definition Monitoring – ‘.. to watch and check something over a period of time in order to see how it develops, so that you can make any necessary changes’ (Cambridge Dictionaries) Reason Anaesthesia and surgery are serious invasions on the physiologic stability of the human body. Careful monitoring of the patient during and after surgery allows the anesthesiologist to identify problems early, when they can still be corrected Evidence ASA Closed Claims Projects A review of 1,175 closed claims indicated that about one-third of the negative outcomes could have been prevented by application of additional monitors. The adverse outcomes judged preventable by additional monitoring (end tidal CO2 and pulse oximetry) are eleven times more costly than those mishaps not judged preventable. Tinker JH, Dull DL, Caplan RA, Ward RJ, Cheney FW: Role of monitoring devices in prevention of anesthetic mishaps: A closed claims analysis. Anesthesiology 71:541-546, 1989 Clinical physical examination of various body systems by observations, palpation and auscultations Fluid loss Measure blood volume loss Measure weight of gauze Measure urine output Measure cardiovascular parameters like BP HR Device and Measurements Where we use machines to help us in checking patients. Standard ECG Pulse oximeter Blood pressure Capnograph Neuromuscular function monitor Temperature FiO2 Airway pressure Agent monitoring Monitoring of patient Why When What How Limitations Errors Complications ECG Detect electrical activities of heart Rate, Rhythm, ST changes Signal is boosted using amplifier cover frequency 0.05 –100 Hz Filters out frequencies – ‘noise’ Monitoring (0.5-40 Hz) and diagnostic mode (0.05-100Hz for ST segment) The leads configuration Lead II R arm, L arm, indifferent Ideal for arryhthmias CM5 R-manubrum, L(V5) - 5th ICS AAL, indifferent–L shoulder Detects