The clinical monitoring of a patient undergoing any type of anaesthesia must include regular assessment and recording of the following:
- Circulation. To ensure the adequacy of the patient’s circulatory function during all anesthetics.
• The circulation must be monitored at frequent and clinically appropriate intervals by detection of the arterial pulse, ECG and measurement of arterial blood pressure. Clinical evaluation by palpation of a pulse, and auscultation of heart sounds is of added value. Ventilation. To ensure adequate ventilation of the patient during the anaesthetic period.
- Ventilation must be monitored continuously by Qualitative clinical signs such as chest excursion, observation of the reservoir breathing bag and auscultation of breath sounds are useful. Quantitative monitoring of the volume of expired gas is strongly encouraged.
• When an endotracheal tube or laryngeal mask is inserted, its correct positioning must be verified by clinical assessment and by identification of carbon dioxide in the expired gas.
• During regional anesthesia (with no sedation) or local anesthesia (with no sedation), the adequacy of ventilation may be evaluated by continual observation of qualitative clinical signs.
• During moderate or deep sedation the adequacy of ventilation shall be evaluated by continual observation of qualitative clinical signs and monitoring for the presence of exhaled carbon dioxide unless precluded or invalidated by the nature of the patient, procedure, or equipment.
- Oxygenation. To ensure adequate oxygen concentration in the inspired gas and the blood during the anesthetics period.
• Oximetry values must be interpreted in conjunction with clinical observation of the patient. Adequate lighting and exposure of the patient is important to aid with assessment of patients’ colour.