While maintaining anaesthesia it is essential to monitor the patient. The degree of monitoring is dependent on the condition of the patient. the type of surgery and the sophistication and availability of equipment within a particular institution. For each procedure there are, however, minimum monitoring parameters that must be observed. The minimum monitoring for any procedure includes monitoring of the heart rate and blood pressure. Modern opinion is in favour of a continuous ECG.
Respiratory rate and depth. any signs of obstruction. the patient’s colour, the presence of sweating, lacrimation and muscle movements must be continuously monitored. The anaesthetist must continuously check that the patient is being supplied with oxygen and that there has been no disconnection from the oxygen source or obstruction along the delivery system. All blood loss must be noted and replaced.
The above is the minimum requirement for any patient under an anaesthetic, but monitoring can be expanded to include various aspects of the cardiovascular system (pulsometer. central venous pressure (CVP). Swan-Ganz arterial lines), the respiratory system (capnograph). the urogenital system (urinary catheter), central nervous system (EEG, sensory evoked potentials, and temperature) and neuromuscular system (electromyogram (EMG), nerve stimulator).
The amount of sophisticated monitoring apparatus can become so vast that one can lose sight of the patient and his problems: therefore the basic monitoring mentioned above is always the most important aspect of monitoring and must never be forgotten. Energy, fluid and electrolyte requirements.
The next factor that must be attended to during anaesthesia is energy, fluid and electrolyte requirements. In the adult, short periods without any energy substrate are well tolerated; in neonates and infants, however, this is not so, and it is essential that dextrose be provided during anaesthesia. The maintenance of ﬂuid balance is essential for all patients because of the large shifts in fluid spaces occurring within the body during anaesthesia and surgery. Intravenous ﬂuids are necessary for all but the smallest procedures.
The amount of fluid required intra-operatively is dependent on the period of starvation prior to surgery, the type, extent and site of surgery, the mass of the patient and the degree of blood loss. It is essential that the volume of fluid circulating should be adequate, thus maintaining perfusion of all essential organs and ensuring that the kidneys continue to function and are enabled to rid the body of waste products.
For adults a solution resembling plasma in its electrolyte concentration is preferred for fluid maintenance and replacement during anaesthesia. A blood loss in excess of 10-15% of the blood volume should always be replaced with blood. In certain circumstances blood will be replaced earlier. Health Executive Recruitment Agency provides access to well paid jobs in Australia.