,*,Monitoring in Anesthesia,Topic module,1.,2.,3.,(NIBP,SpO2,ECG,ET-CO2),Contents,Introduction,What is monitoring?,Which,Why and How to monitor?,Level of monitoring,Standards for basic intraoperative monitoring(ASA),Systematic monitoring,Conclusion,Monitoring:A Definition,.interpret available clinical data to help recognize present or future mishaps or unfavorable system conditions,.not restricted to anesthesia,(change“clinical data”above to“system data”to apply to aircraft and nuclear power plants,),What is monitoring?,to monere,(,),Physiologic parameter&Patient safety parameter,Clinical skills&Monitoring equipment,Data collection,interpretation,evaluation,decision,Problem seeking,Severity assessment,Therapeutic assessment,Evaluation of Anesthetic interventions,Patient Monitoring and Management,Involves,Things you measure,(physiological measurement,such as BP or HR),Things you observe,(e.g.observation of pupils),Planning to avoid trouble,(e.g.planning induction of anesthesia or planning extubation),Inferring diagnoses,(e.g.unilateral air entry may mean endobronchial intubation),Planning to get out of trouble,(e.g.differential diagnosis and response algorithm formulation),Level of monitoring,Routine/Specialize/Extensive,Non-equipment/Non-invasive/Minimally invasive,/Penetrating/Invasive/Highly invasive,Systematic,Respiratory/Cardiovascular/Temperature/Fetal,Neurological/Neuro-muscular/Volume status&Renal,Standards for basic intraoperative monitoring,(ASA),Standards for basic intraoperative monitoring(ASA:,American Society of Anesthesiologists),Standard I,Qualified anesthesia personnel shall be present in the room throughout the conduct of all GA,RA,MAC,Standard II,During all anesthetics,the patients,respiratory,(ventilation,oxygenation),circulation,and,temperature,shall be continually evaluated,Monitoring in the Past,Visual monitoring of respiration and overall clinical appearance,Finger on pulse,Blood pressure(sometimes),Monitoring in the Past,Finger on the pulse,Harvey Cushing,Not just a famous neurosurgeon but the father of anesthesia monitoring,Invented and popularized the anesthetic chart,Recorded both BP and HR,Emphasized the relationship between vital signs and neurosurgical events,(increased intracranial pressure leads to hypertension and bradycardia),Examples of Multiparameter Patient Monitors,Some Specialized Patient Monitors,Depth of Anesthesia Monitor,Evoked Potential Monitor,Transesophageal,Echocardiography,Cardiovascular monitoring,Routine monitoring,Cardiac activity,Non-invasive blood pressure(NIBP),Electrocardiography(ECG),Advanced monitoring,Direct arterial blood pressure,Cardiac filling pressure monitor,Central venous pressure,Pulmonary capillary wedge pressure,Cardiovascular monitoring,Electrocardiography,Cardiac activity,Arrhythmia:Lead II,Myocardial ischemia:ECG criteria,Electrolyte imbalance,Pacemaker function,Cardiovascular monitoring,ECG,1.,lead II,modified V5,2.,-arrhythmia:bradycardia,tachycardia,AF,PVC,VT,VF,-Myocardial ischemia,-electrolyte imbalance,Cardiovascular monitoring,Non-invasive blood pressure(NIBP),Cuff:width 120-150%limb diameter,air bladder includes more than halfway around limb,Manometer:aneroid,mercury,Detector:manual,automated,Cardiovascular monitoring,Non-invasive blood pressure,Inaccurate:cuff size,inflated pressure,shivering,cardiac arrhythmia,severe vasoconstriction,Proper application,Narrow cuff,Loose cuff,Cardiovascular monitoring,Direct arterial pressure monitor,Indications,Continuous blood pressure monitor:anticipated cardiovascular instability,direct manipulation of cardiovascular system,inability to accurate measurement directly,Frequent arterial blood sampling:ABG,Acid-base/electrolyte/glucose disturbance,Coagulopathies,Cardiovascular monitoring,Direct arterial pressure monitor,Contraindications,Local infection,Impaired blood circulation:Raynauds phenomenon,DM,Risks of thrombosis:hyperlipidemia,previous brachial artery cannulation,Modified Allens test?(,),Cardiovascular monitoring,Direct arterial pressure monitor,Complications,Direct trauma:AV-fistula,Aneurysm,Hematoma,Infections,Thrombosis,Embolization,Massive blood loss,Cardiovascular monitoring,Cardiac filling pressure monitor,Frank-Starling curve:optimum Preload maximize ventricular performance(Stroke volume,CO.),Preload=Myocardial fiber length(2.2 micron),LV Preload,LVEDV,LVEDP,LAP,PCWP,PAP,RVP,RAP,CVP,Myocardium function,LV compliance,Mitral valve,Airway pressure,Pulmonary vascular resistance,Pulmonic valve,Tricuspid valve,Cardiovascular monitoring,Cardiac filling pressure monitor,LV Preload,LVEDV,LVEDP,LAP,PCWP,PAP,LVEDP,RVEDP,RAP,CVP,Cardiovascular monitoring,Cardiac filling pressure monitor,PCWP:Pulmonary capillary wedge pressure,CVP:Central venous pressure,Cardiovascular monitoring,PCWP:Pulmonary capillary wedge pressure,CVP:Central venous pressure,Fluid Challenge test,to optimize preload and maximize Cardiac performance,Respiratory monitoring,Ventilatory monitoring,Oxygenation monitoring,Mach