MONITORING

Appropriate patient monitoring is a universal requirement for delivery of safe anesthetic care. The ASA has developed and published standards for basic anesthetic monitoring requiring that qualified anesthesia personnel be present throughout conduct of the anesthesia and that the patient's oxygenation, ventilation, circulation, and temperature be continually evaluated.^[4] Provision is made for the absence of anesthetic personnel from the immediate vicinity of the patient if required for safety (i.e., in the presence of radiation hazards), provided that provision is made for ongoing adequate patient monitoring. Oxygen concentrations of inspired gas should be monitored with a low-concentration alarm in use. Blood oxygenation should be monitored with pulse oximetry. Ventilation should be monitored by observation of the patient. When present, endotracheal tube position must be verified by observation and by end-tidal carbon dioxide detection. Continuous end-tidal carbon dioxide analysis should be performed. When mechanical ventilation is used, a disconnect alarm must be present with an audible alarm. Circulation is monitored by continuous display of the electrocardiogram, as well as by measurement of arterial blood pressure at a minimal interval of 5 minutes, as well as other assessments such as auscultation, palpation of pulse, invasive blood pressure monitoring, or oximetry. When changes in body temperature are anticipated or suspected, patient temperature should be assessed.