The Faculty of Anesthetists, R.A.C.S. recommends the monitoring of certain fundamental physiological variables during anesthesia. Clinical judgment will determine how long monitoring should be continued following completion of anesthesia.
Some or all of these basic recommendations will need to be exceeded routinely depending on the physical status of the patient, the type and complexity of the surgery to be performed, and the requirements of anesthesia. Occasionally some of the recommended methods of monitoring may be impractical or inappropriate. Departments of Anesthesia should establish policies to deal with such circumstances.
The following recommendations refer to patients undergoing general anesthesia or major regional anesthesia for diagnostic or therapeutic procedures and should be interpreted in conjunction with other policy documents published by the Faculty of Anesthetists. AU policy documents are revised from time to time as required by changing clinical practice and developments in technology.
The Health Care Facility in which the procedure is being performed is responsible for provision of equipment for anesthesia and monitoring on the advice of one or more designated specialist anesthetists, and for effective maintenance of this equipment.
Clinical monitoring by a vigilant anesthetist is the basis of patient care during anesthesia. This should be supplemented by appropriate devices to assist the anesthetist.
A medical practitioner whose sole responsibility is the provision of anesthetic care for that patient must be constantly present from induction of anesthesia until safe transfer to Recovery Room staff or Intensive Care Unit has been accomplished. Such medical practitioner must be appropriately trained in Anesthesia, or be a Trainee Anesthetist supervised in accordance with the Faculty Guidelines for Supervision of Trainees. (Faculty Policy Document E3 (1986))
It is recognized that brief absences of the person primarily responsible for the anesthetic may be unavoidable. In such instances that person shall delegate, temporarily, observation of the patient to a medically qualified person who is judged to be competent for the task.
The individual anesthetist is responsible for monitoring the patient and should ensure that appropriate monitoring equipment is available. Where there is an environmental risk to staff, e.g. radiation, adequate facilities must exist to enable remote patient monitoring.
2. PATIENT MONITORING
The circulation must be monitored at frequent and clinically appropriate intervals by deW6on of the arterial pulse and measurement of the arterial blood pressure.
Respiration must be monitored continuously by observation of rate and depth.
The patient must be observed at frequent intervals for evidence of central cyanosis. If an oximeter is in use its displayed values should he assessed by frequent observation of the patient.
The following recommendations for equipment should be implemented as soon as possible, and in any case no later than 1st January, 1990:
3.1 Oxygen Supply Failure Alarm
An automatically activated device to monitor oxygen supply
pressure and to warn of low pressure must be fitted to the anesthetic machine.
3.2 Oxygen Analyze
A device incorporating an audible signal to warn of low oxygen
concentrations, correctly fitted in the breathing system, should be in continuous operation for every patient when an anesthetic machine is in use.
3.3 Pulse Oximeter
Pulse oximetry provides evidence of saturation of the hemoglobin of arterial blood and identifies arterial pulsation at the site of application. A pulse oximeter must be exclusively available for every anaesthetized patient.
3.4 Alarms for Breathing System Disconnection or Ventilator Failure
When an automatic ventilator is in use, a device capable of warning promptly of a breathing system disconnection or ventilator failure must be in continuous operation. It is desirable that this device be automatically activated.
3.5 Electrocardiograph Equipment
To monitor and continually display the electrocardiograph should be available for every anaesthetized patient.
3.6 Temperature Monitor
Equipment to monitor temperature should be available for every anaesthetized patient.
3.7 Carbon Dioxide Monitor
Monitoring of tidal carbon dioxide should be available for those patients where it is clinically indicated.
3.8 Neuromuscular Function Monitor
Monitoring of neuromuscular function should be available for those patients where it is clinically indicated.
3.9 Other Equipment
When clinically indicated, equipment to monitor other physiological variables should be available.