Italy, Japan Publish Anesthesia Monitoring Protocols – Italian Society “Recommends”

Prof. G. Torri; Ida Salvo

To the Editor

Because of the growing consensus among anaesthetists that considerable improvements in patient safety can be effected by the adoption of better monitoring standards, the Committee for Safety in Anaesthesia of the Italian Society of Anaesthesia, Analgesia, Rianimation and Intensive Care (S.I.A.A.R.T.I.) has published ‘Recommendations for standards of monitoring in Anaesthesia,’ which are reprinted below for the interest of our colleagues in other countries working on the same issues.

Prof. G. Torri and Ida Salvo Milan, Italy

Recommended Anaesthesia Equipment for General Anaesthesia in Italy:

***Highly recommended:

emergency equipment

oxygen analyzer

disconnection alarm

ECC monitor and recorder, HR

BP, non invasive

defibrillator

***Recommended:

spirometer

pulse oximetry

capnometer

***Available.

temperature monitoring

relaxometry

CVP monitoring

arterial BP, invasive

emergency laboratory

1. PATIENT VIGILANCE DURING GENERAL ANAESTHESIA

1.1 Continuous vigilance

General anaesthesia, local-regional anaesthesia and sedations involving risk of unconsciousness which may be required also out of the operating theatre must be performed by a registered attending anaesthetist which in Italy is a specialized anaesthetist controlling anaesthesia and vital signs of the patient throughout the entire conduct of anaesthesia and sedation.

1.2 Remote control

An exception is made when there is a direct known hazard (e.g., radiation) to the anaesthetist. In these cases an adequate provision for remote observation and monitoring of the patient must be made.

1.3 Relief of the anaesthetist.

The anaesthetist that starts a procedure normally ends it. When this is not possible and patients have to be handed over to another anaesthetist, the last should be made aware of the relevant information concerning the conduct of anaesthesia and the use of the equipment.

The patient’s vital signs and the time of the “hand-over” should be documented on the anaesthesia chart.

2. CONTROL OF TECHNICAL AND PHARMACOLOGICAL DEVICES

Before starting anaesthesia the anaesthetist should carefully check on the functioning of the anaesthesia machine, medical gas supply lines, drugs and immediate life support devices for emergency circumstances.

3. CLINICAL OBSERVATION AND MONITORING DEVICES FOR GAS EXCHANGES

3.1 An analyzer for continuous measurement of oxygen delivery with audible and visual high-low oxygen alarms is highly recommended on all anaesthesia circuits.

3.2 An adequate lightening of the operating theatre is required. Whenever possible this observation should be supplemented by pulse oximetry measuring continuous oxygen saturation.

4. VENTILATION

During mechanical ventilation, in addition to clinical observation, the patient’s respiratory function must be monitored with one of the following devices:

a) a disconnection alarm

b) a spirometer with audible and visual high-low alarms set in the expiratory line

c) a capnometer monitoring end-tidal carbon dioxide

5.CARDIOVASCULAR CLINICAL CONTROL AND MONITORING DEVICES

5.1 For all patients undergoing general anaesthesia an ECG with heart rate and alarms continuously displayed from induction until leaving the operating theatre is highly recommended.

6. TEMPERATURE CONTROL

6.1 Normothermic conditions must be preserved. During every general anaesthesia, besides clinical evaluation, there should be readily available a mean to measure the patients temperature continuously.

7. All data provided by mechanical, electronical and clinical monitoring should be carefully reported on the anaesthesia chart.

8. All devices must meet CEN and ISO requirements and assure electrical safety (IEC 601.1; CEI 62.5).