VMED 5267 - Anesthesia
Monitoring
1. Outline the im- - ¡GA carries an inherent risk for every patient
portance of anes- - Individual ditterences in sensitivity to anesthetic
thetic -Cardiovascular and respiratory side ettects
monitoring -Unexpected adverse responses can always occur
during GA? -Monitoring decreases the odds of death
-Warning signals- earlier intervention
-It helps to understand the anesthetic drugs
2. What needs to be - Anesthetic depth
monitored -Cardiovascular system
dur- ing GA? -Pulmonary system
-Temperature
-Nociception
3. Classify Hands on assessment
between:
-Anesthesia Depth, Circulation, Pulmonary System, Temperature, Leaks
"hands on
-"Field anesthesia"
moni- toring"
and mon- Monitoring equipment
itoring equip-
-A machine should never be solely relied upon = use common sense
ment?
(treat pt not machine)
-We should be familiar: Position of electrodes from ECG...
4. What reflexes can - Palpebral: medial canthus and third lid elevated
be assessed -Corneal: should never disappear
to assess -Gad reflex or jaw tone
depth of -Limb withdrawal reflexes (common in exotics)
anesthesia? -Anal tone
-Righting reflex (exotics)
-Ocular signs: lacrimation, pupil size, nystagmus ...
1/
20
, VMED 5267 - Anesthesia
Monitoring
5. What are the Stage I: awake state of awareness
stages and
planes of Stage II: excitement stage heralded by spontaneous muscular movement
anes- thesia -Not really seen with premedication
isand where
the goal during
Stage III: cessation spontaneous movements (surgical stage of
anesthesia)
10. GA?
6. How is circula- tion assessed on hands on
assess- ment?
How is the pulmonary sys- tem assess on
hands-on exam?
7. How is tempera- ture assessed on hands-on
exam?
How are leaks assessed for on hands-on
exam?
8.
Monitoring equipment?
9.
2/
20
, VMED 5267 - Anesthesia
Monitoring
-P L
l -Plane 3: Deep-to
a medium
n -Plane 4: Deep -Electrocardiography
e
-Arterial blood pressure
1
Stage IV: deep::
:
Extreme depression of
L
the CNS
i
g
-Mucous membranes
h
(pink, moist, tacky,
t
congestive, CRT...)
-P
-Palpation peripheral
l
pulses
a
(synchronize/asynchro
n
nized, weak,
e
bounding...)
2
: -Cardiac auscultation
L (both sizes L and R,
i hand palpation...)
g
h
t -Movement
- chest/bag
M -Manual bag inflation:
e lung compliance
d
i
u
m Skin temperature
=
G
O Smelling inhalant,
A noises ..
3/
20
Monitoring
1. Outline the im- - ¡GA carries an inherent risk for every patient
portance of anes- - Individual ditterences in sensitivity to anesthetic
thetic -Cardiovascular and respiratory side ettects
monitoring -Unexpected adverse responses can always occur
during GA? -Monitoring decreases the odds of death
-Warning signals- earlier intervention
-It helps to understand the anesthetic drugs
2. What needs to be - Anesthetic depth
monitored -Cardiovascular system
dur- ing GA? -Pulmonary system
-Temperature
-Nociception
3. Classify Hands on assessment
between:
-Anesthesia Depth, Circulation, Pulmonary System, Temperature, Leaks
"hands on
-"Field anesthesia"
moni- toring"
and mon- Monitoring equipment
itoring equip-
-A machine should never be solely relied upon = use common sense
ment?
(treat pt not machine)
-We should be familiar: Position of electrodes from ECG...
4. What reflexes can - Palpebral: medial canthus and third lid elevated
be assessed -Corneal: should never disappear
to assess -Gad reflex or jaw tone
depth of -Limb withdrawal reflexes (common in exotics)
anesthesia? -Anal tone
-Righting reflex (exotics)
-Ocular signs: lacrimation, pupil size, nystagmus ...
1/
20
, VMED 5267 - Anesthesia
Monitoring
5. What are the Stage I: awake state of awareness
stages and
planes of Stage II: excitement stage heralded by spontaneous muscular movement
anes- thesia -Not really seen with premedication
isand where
the goal during
Stage III: cessation spontaneous movements (surgical stage of
anesthesia)
10. GA?
6. How is circula- tion assessed on hands on
assess- ment?
How is the pulmonary sys- tem assess on
hands-on exam?
7. How is tempera- ture assessed on hands-on
exam?
How are leaks assessed for on hands-on
exam?
8.
Monitoring equipment?
9.
2/
20
, VMED 5267 - Anesthesia
Monitoring
-P L
l -Plane 3: Deep-to
a medium
n -Plane 4: Deep -Electrocardiography
e
-Arterial blood pressure
1
Stage IV: deep::
:
Extreme depression of
L
the CNS
i
g
-Mucous membranes
h
(pink, moist, tacky,
t
congestive, CRT...)
-P
-Palpation peripheral
l
pulses
a
(synchronize/asynchro
n
nized, weak,
e
bounding...)
2
: -Cardiac auscultation
L (both sizes L and R,
i hand palpation...)
g
h
t -Movement
- chest/bag
M -Manual bag inflation:
e lung compliance
d
i
u
m Skin temperature
=
G
O Smelling inhalant,
A noises ..
3/
20
