BASIC MONITORING IN ANAESTHESIA.....pptx

Presentation on Basic monitoring in anaesthesia

1. BASIC MONITORING IN ANAESTHESIA( PULSE OXIMETRY,NIBP,ECG,ETCO2,TEMP. ) PRESENTER: DR AMIT KU PRADHAN GUIDE:DR AMBIKA PRASAD TRIPATHY

2. STANDARDS OF MONITORING

3. GUIDELINES 1.The anaesthetist must be present and care for the patient throughout the conduct of an anaesthetic . 2. Minimum monitoring devices (as defined in the recommendations) must be attached before induction of anaesthesia . 3. A summary of information provided by all monitoring devices should be recorded on the anaesthetic record. 4.The anaesthetist must ensure that all anaesthetic equipment, including relevant monitoring equipment, has been checked before use. 5. These recommendations state the monitoring devices that are essential (‘minimum’ monitoring) and those that must be immediately available during anaesthesia .

4. 6 Additional monitoring may be necessary as judged appropriate by the anaesthetist . 7 Minimum monitoring should be used during the transfer of anaesthetised patients. 8 Provision, maintenance, calibration and renewal of equipment are the responsibilities of the institution in which anaesthesia is delivered. 9 All patient monitoring equipment should be checked before use in accordance with the AAGBI guideline Checking Anaesthetic Equipment 2012.

5. ECG ;ELECTROCARDIOGRAPHY A transthoracic interpretation of the electrical activity of heart over time captured and externally recorded by skin electrodes. Indication: Gold standard for diagnosis of cardiac arrythmias Detect electrolyte disturbances Detection of conduction abnormalities Screening tool for IHD in stress test Help with pulm embolism, hypothermia etc.

6. SOURCE OF ERROR: 1.false high reading: small cuff cuff applied too loose extreimity below heart level 2.False low reading: large cuff extreimity above heart level quick deflation

7. RESPIRATORY MONITORING

8. principle Works on principle of Beer Lambert law. It relates transmission of light through a solution to the concentration of the solute in the solution. Oxyhemoglobin absorbs more infrared light(940nm) Deoxyhemoglobin absorbs more red light(660nm) Ratio of absorption of red and ir wavelength analysed by microprocessor

9. ERRORS: 1.Carboxyhaemoglobin: overestimate the real value 2.Methemoglobinemia: fix saturation of 85% 3.Anaemia:underestimation of actual value 4.Hypovolemia:false low spo2 reading 5.Nail polish(mainly blue):impairs transmission of light hence false reading 6.shivering:const. finger movement impairs transmission 7.skin pigmentation and dyes

10. PHASE 1: inspiratory baseline reflects inspired gas devoid of co2 PHASE 2: Expiratory upstroke transition from phase1(dead space) to phase 3 (alveolar phase) PHASE 3: alveolar plateu phase represents gas coming from alveoli . PHASE 0: inspiratory downstroke phase represents patient inhalation

11. ETCO2 IS ZERO IN: esophageal intubation accidental extubation complete obstruction disconnection ventilation failure cardiac arrest . Decrease ETCO2: pulmonary embolism less production of co2(hypothermia) less perfusion(in hypotension) hyperventilation

12. ANGLES OF CAPNOGRAPH ALPHA ANGLE: between phase 2 and 3 normally 100-110 decreased in obstructive lung diseases increased in airway obstruction . BETA ANGLE : between phase 3 and phase 0 normally around 90 degree increased in rebreathing decreased in airway obstruction

13. Increased ETCO2 : exhausted sodalime or defective valve of closed circuit Increased production of co2 ( fever,malignant hyperthermia) Decreased ventilation (nm disease,central resp depression by opioids,thoracic surgeries) Bicarbonate administration Bronchial intubation

14. TEMPRETURE MONITORING

15. SUMMARY .Primary goal of anaesthesia is to keep the pt as safe as possible in the peroperative period. .Careful monitoring of pt during and after surgery allows the anaesthesiologist to identify problem early and corrected. . VIGILANT ANAESTHESIST IS THE BEST MONITOR.

16. source MILLER’S ANAESTHESIA ANAESTHESIA REVIEW FOR DNB AJAYA YADAV (6 TH )

17. THANK YOU