Monitoring in Anaesthesia Flashcards by Iseoluwa Ojo

Monitoring

Types:
List them

Continuous
Continual
Non-invasive
Invasive

How well did you know this?

Not at all

Perfectly

Monitoring

Types:
• Continuous – __________________
 Continual – __________________
• Non-invasive
Invasive

without any interruption

repeated at regular intervals

How well did you know this?

Not at all

Perfectly

Standard for Basic Intra-operative Monitoring:
•Presence of ________________ throughout the procedure
•Evaluation of –
________,________,_______,________
•__________ & _________ monitoring

qualified anaesthetic personnel

Oxygenation
Ventilation
Circulation
Body temp

Clinical & Equipment

How well did you know this?

Not at all

Perfectly

Resp Sys monitoring
Clinical
•Colour – _______
•Movement of _________
•Signs of __________
•Signs of __________
•Chest ________
•Chest ________

cyanosis

reservoir bag

obstruction; CO2 retention

excursion; auscultation

How well did you know this?

Not at all

Perfectly

PULSE OXIMETER

• (Invasive or Non-invasive?) measurement of ________ in ________ blood. Also measures ________

• Differential wavelengths of _____ (______nm) and ________ (_______nm) light absorbed by ________-Hb & _____-Hb respectively.

Non-invasive ; O2 saturation

arterial; pulse rate

Red ; 660nm ; Infra- red ; 940nm

deoxy-Hb ; Oxy-Hb

How well did you know this?

Not at all

Perfectly

Pulse oximeter

_____ emits light detected by ___________

LED

photo-detector diode

How well did you know this?

Not at all

Perfectly

Pulse oximeter

The presence of well oxygenated blood → ↑ absorbtion of ______ light
• The presence of more de-oxygenated blood e.g. from difficult intubation, oesophageal intubation will absorb more _____ light

• The ______ calculates what is absorbed and produces a value for SpO2

IRed; Red

PDC

How well did you know this?

Not at all

Perfectly

Pulse oximeter

During _______ blood is pumped into finger →↑ volume of finger demonstrated by the height of the ____________

Systole

plethysmograph

How well did you know this?

Not at all

Perfectly

The pulse oximeter

Displays the ________ and ————- of the blood
•A probe is placed top to bottom over a digit from which light is emitted, absorbed and detected.
•May be inaccurate in some situations

pulse rate and oxygen saturation

How well did you know this?

Not at all

Perfectly

Pulse oximeter

Pulse amplitude gives an indication of _____________

tissue perfusion

How well did you know this?

Not at all

Perfectly

Accuracy of pulse oximeter affected by :

•____Hb (false ↑), ____Hb
•Position – _____,______,_______,_________
•Peripheral vaso_________
•Excess _________
•_______
• ______________
•↓↓ ______ states – hypotension, anaemia, hypothermia
•________ pulsation

Co; met

earlobe, bridge of nose, finger, toe

constriction; ambient light

Dyes; Coloured nail polish

perf; Venous

How well did you know this?

Not at all

Perfectly

Pulse oximeter

Problems:
•Monitors ____________ but provides no direct info about ____________
•Response time of ____________.
•Cannot detect acute ______________.
•_______ or ____________ especially with long application on same site >______ in children.

O2 saturation ; O2 delivery

10 – 20 secs.

acute desaturation.

Burns or pressure sores

> 2 hrs

How well did you know this?

Not at all

Perfectly

OXYGEN ANALYSER
•Essential to monitor __________ in gas mixture

FiO2

How well did you know this?

Not at all

Perfectly

CAPNOGRAPHY
•Measures ________________ .
•Assesses ________________ of ventilation.
•Uses the principle of _______________

expired CO2 concentration.

adequacy

Absorbtion spectrometry

How well did you know this?

Not at all

Perfectly

Capnography

principle of Absorbtion spectrometry –
 Molecules with ___________________ will _____________ .

2 dissimilar atoms

absorb IR light.

How well did you know this?

Not at all

Perfectly

Types of sampling

 ____stream
 ____stream

Main

Side

How well did you know this?

Not at all

Perfectly

Clinical Considerations of capnography :

•Assesses __________ of ventilation
•Allows ventilation to be ________
•Measures __________
•Reliably identifies ___________________.
•Does not reliably detect ________________

adequacy ;modified

respiratory rate

oesophageal intubation.

endobronchial intubation

How well did you know this?

Not at all

Perfectly

ETCO2

End tidal CO2

How well did you know this?

Not at all

Perfectly

Normal ETCO2 = ???

3.5 – 5.7 kPa

How well did you know this?

Not at all

Perfectly

Capnography

Phases of

Exp I – __________ gas
II – _______________________ gas
III – _________ gas
IV – _________

Phases of Exp I – Dead space gas
II – Dead space gas + alveolar gas
III – Alveolar gas
IV – Inspiration

How well did you know this?

Not at all

Perfectly

Factors that increase ETCO2

•_________
•_____ventilation
•_______
•___________________
•_______ storm

ETCO2
•Rebreathing
•Hypoventilation
•Sepsis
•Malignant hyperthermia
•Thyroid storm

How well did you know this?

Not at all

Perfectly

Factors that decrease ETCO2

____________
•____________
•____________
•_________ventilation
•________perfusion
•______thermia
•_______metabolism

Disconnection
•Cardiac arrest
•Pulm Embolism
•Hyperventilation
•Hypoperfusion
•Hypothermia
•Hypometabolism

How well did you know this?

Not at all

Perfectly

Capnography tracings

____________-Elevated baseline FiCO2 is high – 1.6kPa

Rebreathing

How well did you know this?

Not at all

Perfectly

Capnography tracings

•In rebreathing, ______ will be high – exhaustion of ______, ______ fresh gas

•In COAD – slow rising of ________, ________ is peaked

•In Recovery from NMB – patient gains ____________ and attempts __________ (___________)

FiCO2 ; soda lime

low ; Phase II, Phase III

spontaneous ability ;take a breath

curare cleft

How well did you know this?

Not at all

Perfectly

Sudden precipitous fall in ETCO2 with ________ and _______ No ETCO2 with ______________

cardiac arrest disconnection oesophageal intubation

O2 Failure warning device : • _________ alarm of at least _____ decibels •Powered by _________ only. •Cuts off _________ supply •Open circuits to _________. •Cannot be _________ or _________ until _________ is restored

Auditory ; 60 ; O2 pressure anaesthesia gas ; atmospheric air. switched off ; O2 supply

PRECORDIAL STETHOSCOPE • Placed over the ______ side of the ______ •Confirms position of ______  Confirms ______ of ______  Assesses quality of __________  Assesses quality of ___________  Assesses ______ & ______ • Essential for ______ pts.

left ; chest ETT ; adequacy of ventilation breath sounds; heart sounds HR & rhythm paediatric pts.

Oesophageal stethoscope Can incorporate – •__________________ • __________ •______________

Temp probe (core temp) ECG leads Atrial pacemaker

Oesophageal stethoscope Contraindicated in – _____________ or ____________ •Only used in ___________ patients.

oesophageal varices or stricture. intubated

Cardiovascular System •Clinical  ________  __________  _____________  ______________

Pulse Heart sounds Extremities Urine output.

Cardiovascular System •Clinical  Pulse – ____,______,_________  Heart sounds –_____,_________ esp in paeds  Extremities – warm, dry & pink, capillary refill  Urine output.

rate, rhythm, volume rate, intensity

ELECTROCARDIOGRAM •Monitors ____________ of the heart. •Does not give any indication of ______

electrical activity ; CO

Electrocardiogram •Uses  Determine _________  Diagnosis of ________, ________ conduction defect Diagnosis of __________ _______

heart rate ischaemia, arrhythmias electrolyte imbalance

Electrocardiogram _____ or _____ Lead configuration  Lead II – best detects _________  Lead I – best detects __________

3 or 5 arrhythmias ischaemia

Electrocardiogram Inaccuracies : •_____________ electrodes – should be over ________________. •_________ contact – conductive gel b/w skin & electrode. •Muscular activity e.g __________ , ↑ tone •____________ interference e.g ____\___ •Improper placement of ________________

electrodes ; bony prominences. Poor skin; shivering Electromagnetic interference ; diathermy diathermy pads

ARTERIAL BLOOD PRESSURE •Pulsatile arterial pressure due to rhythmic ventricular contraction. •Reflects organ blood flow.  Sys BP  Diast BP  Pulse pressure = _______ -_______  MAP = ___________

SBP – DBP MAP = DBP + 1/3 PP

Non-invasive Blood Pressure • Relative C/I – site of ___________

vascular shunts

Non-invasive Blood Pressure • Pneumatic cuff • Palpable artery – usually ________ • Hg manometer/ aneroid gauge to display cuff press __________________ – used in electronic devices • Must be measured at least ______________

brachial Oscillotonometry every 5 minutes

Pneumatic cuff  Different cuff sizes- adult to neonatal (12cm std adult)  Occupy _____ of upper arm  Width of bladder –___________% > ———— of arm ________ of bladder over brachial artery

2/3 20- 50; diameter Mid-point

Methods of detection of arterial blood pressure : •__________ – no DBP or MAP. •___________– of ________ sounds. •__________ •_______________

Palpation Auscultation; Korotkoff Oscillotonometry Plethysmography

Inaccuracies of arterial blood pressure : •Over-reads BP with a _______ cuff, under- reads with _______ cuff. •Atrial fibrillation and other arrhythmias •Palpation difficult in _______ pts. •Korotkoff sounds difficult to hear in _______ or peripheral vaso _______

small cuff ; large cuff Obese hypotension ; vasoconstriction

Invasive Arterial pressure •_____________ in artery to provide beat-to-beat arterial press monitoring.

Catheter

Invasive arterial blood pressure •Indications –  __________ hypotension  __________________ BP swings  _____________ disease  Need for _______ arterial blood gas sampling

Elective ; Large intra-op BP End-organ; multiple

Invasive Blood Pressure •Risk of arterial _________ • _______ Test is done to test adequacy of ________ collaterals

thrombosis Allens; ulnar

Sites of Invasive blood pressure  _________ art.  _________ art.  _________ art.  ________________

Sites  Radial art.  Brachial art.  Femoral art.  Dorsalis pedis

Complications of invasive blood pressure  ____________  __________ / __________  __________, skin necrosis  ________ damage  Inadvertent __________

•Complications –  Haematoma  Thrombosis / embolism  Infection, skin necrosis  Nerve damage  Inadvertent drug inject

CENTRAL VENOUS PRESSURE •Cannulation of vein in ________ to measure filling pressure of the _________. •Reflects Blood volume (________), _____ heart function

thorax ; Rt atrium. preload right

CENTRAL VENOUS PRESSURE •Indications-  Fluid mx in __________ _______ access  Infusion of ______ drugs ______________________ _________ of air embolism

hypovolemia Venous; caustic Total Parenteral Nutrition Aspiration

Sites of Central venous Cannulation Mention 4

Int Jugular Subclavian Femoral Basilic

Central venous pressure Measuring device: _______________ (cmH2O) _________________ (mmHg) •Procedure  Aseptic.  Reqs _____ monitoring •Normal value ___-____cmH2O

Water manometer Pressure transducer ECG - 0 – 8

Urine Output • _________ , _________ surgeries or if _________________ is anticipated • Requires a urinary catheter • Aim for ____ml/kg/hr • Must be measured every _________ • Check that catheter is not _________ or _________

Major ; prolonged significant blood loss is anticipated 1; hour kinked or misplaced

Central Nervous System DEPTH OF ANAESTHESIA •Clinical _______ stages of anaesthesia  Sympathetic stim – ___,_____,______,_______

Guedels HR, BP, sweating, lacrimation

BiSpectral Index (BIS ) • to measure _____________________ • Combines _____________ and ______________ technology • Electrodes transmit to the monitor

Depth of Anaesthesia monitor Electro encephalography and Electromyography

Neuromuscular Junction • Peripheral Nerve Stimulator  Assess ________ , ________, ________ or ________ response to electrical stimulus.  Use ________, ________ or ________ nerve • Train of ________

visual, tactile, mechanical or EMG ulnar, facial or tibial nerve Four

Temperature • ____________ •__________________thermometer

•Thermistor •Infrared tympanic thermometer

Temperature •Peripheral Skin temp – _________ •Core temp – _________, _________, _________, _________, _________, _________ (unreliable)

Peripheral Skin temp – axilla •Core temp – lower oesophagus, tympanic membrane, nasopharynx, bladder, pulmonary artery, rectum (unreliable)

Thermistor – incorporated into _______________, _______________

oesophageal stethoscope Pulmonary artery catheter

BLOOD LOSS •Clinical  Degree of pallor – _____________ ___,_____,_________  ____________ •Gravimetric  Blood in ________ ________ of swabs – ____g = ___ ml.

mucous membrane HR, BP, capillary refill Urine output suction bottles; Weighing 1;1

BLOOD LOSS MEAUSREMENT MENTION 5

Clinical Gravimetric Colorimetric Visual estimate POC

BLOOD LOSS Visual Estimate  ___________ , surgical ___________, ___________, ___________ •Colorimetric  Measures ___________ in washed swabs & drapes Must know patient’s ___________ Can only be done at the ___________ of surgery

Suction bottles, surgical gauze, drapes, floor Hb concentration ; pre-op Hb end

Haemoglobinometer A ________ device (portable device) that determines _______ at the bedside using a drop of blood.

point-of-care haemoglobin

Essential Intra-operative monitoring •Continuous presence of the ____________ . •____________ •Continuous ____________ •Continuous ____________ •____________ alarm (if ____________ vent) •Continuous ____________ •BP at least every _________

anaesthetist. O2 analyser; Pulse oximetry Capnography ; Disconnection mechanical ;ECG 5 mins