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1.   INTRODUCTION

1.1   Monitoring of fundamental physiological variables during anaesthesia is essential. Clinical judgement will determine how long this monitoring should be continued following completion of anaesthesia.

1.2   The Health Care Facility in which the procedure is being performed is responsible for provision of equipment for anaesthesia and monitoring on the advice of one or more designated specialist anaesthetists, and for effective maintenance of this equipment (see College Professional Document T1 Recommendations on Minimum Facilities for Safe Administration of Anaesthesia in Operating Suites and other Anaesthetising Locations.)

1.3   Some or all of the recommendations in this document may need to be exceeded depending on the physical status of the patient, the type and complexity of the surgery to be performed as well as the requirements of anaesthesia.

1.4   Monitoring must always be used in conjunction with careful clinical observation by the anaesthetist as there are circumstances in which equipment may not detect unfavourable clinical developments.

1.5   The following recommendations refer to patients undergoing general anaesthesia or major regional anaesthesia for diagnostic or therapeutic procedures and should be interpreted in conjunction with other Professional Documents published by the Australian and New Zealand College of Anaesthetists.

2.   CLINICAL MONITORING BY AN ANAESTHETIST

2.1   Clinical monitoring by a vigilant anaesthetist is essential for safe patient care during anaesthesia. This should be supplemented by appropriate devices to assist the anaesthetist.

2.2   A medical practitioner whose sole responsibility is the provision of anaesthetic care for that patient must be constantly present from induction of anaesthesia until safe transfer to Recovery Room staff or Intensive Care Unit has been accomplished. This medical practitioner must be appropriately trained in Anaesthesia, or be a Trainee Anaesthetist supervised in accordance with College Professional Document TE3 Policy on Supervision of Clinical Experience for Vocational Trainees in Anaesthesia.

2.3   In exceptional circumstances brief absences of the person primarily responsible for the anaesthetic may be unavoidable. In such circumstances that person may temporarily delegate observation of the patient to an appropriately qualified person who is judged to be competent for the task.

2.4   Permanent handover of responsibility must be to an anaesthetist who is able to accept continued responsibility for the care of the patient (see College Professional Document PS10 Guidelines on the Handover of Responsibility during an Anaesthetic).

2.5   The individual anaesthetist is responsible for monitoring the patient and should ensure that appropriate monitoring equipment is available. Some procedures necessitate special monitoring (e.g. MRI scanning) or remote monitoring to reduce the hazard to staff (e.g. radiological procedures). (See College Professional Document T1 Recommendations on Minimum Facilities for Safe Administration of Anaesthesia in Operating Suites and other Anaesthetising Locations).

2.6   Patient Monitoring

2.6.1   Circulation

The circulation must be monitored at frequent and clinically appropriate intervals by detection of the arterial pulse and measurement of arterial blood pressure.

2.6.2   Ventilation

Ventilation must be monitored continuously by both direct and indirect means.

2.6.3   Oxygenation

Oximetric values must be interpreted in conjunction with clinical observation of the patient.Adequate lighting must be available to aid with assessment of patient colour.

3.   MONITORING EQUIPMENT

3.1   Oxygen Analyser

A device incorporating an audible signal to warn of low oxygen concentrations, correctly fitted in the breathing system, must be in continuous operation for every patient when an anaesthesia delivery system is in use.

3.2   Pulse Oximeter

Pulse oximetry provides evidence of the level of oxygen saturation of the haemoglobin of arterial blood and identifies arterial pulsation at the site of application. A pulse oximeter must be in use for every anaesthetised patient.

3.3   Breathing System Disconnection or Ventilator Failure Alarm

When an automatic ventilator is in use, a monitor capable of warning promptly of a breathing system disconnection or ventilator failure must be in continuous operation. This must be automatically activated.

3.4   Electrocardiograph

Equipment to monitor and continually display the electrocardiograph must be available for every anaesthetised patient.

3.5   Temperature Monitor

Equipment to monitor temperature continuously must be available for every anaesthetised patient.

3.6   Carbon Dioxide Monitor

A monitor of carbon dioxide level in inhaled and exhaled gases must be in use for every patient under general anaesthesia.

3.7   Neuromuscular Function Monitor

Equipment to monitor neuromuscular function must be available for every patient in whom neuromuscular blockade has been induced.

3.8   Volatile Anaesthetic Agent Concentration Monitor

Equipment to monitor the concentration of inhalational anaesthetics must be in use for every patient undergoing general anaesthesia from an anaesthesia delivery system where volatile anaesthetic agents are available. Automatic agent identification should be available on new monitors.

3.9   Continuous Blood pressure Monitor

Equipment to provide continuous blood pressure monitoring should be available. In most cases, this refers to a monitor connected via a transducer to an intra-arterial line.

3.10   Monitor of Anaesthetic Effect on the Brain

When clinically indicated equipment to monitor the anaesthetic effect on the brain should be available for use on patients at high risk of awareness during general anaesthesia.

3.11   Other Equipment

When clinically indicated, equipment to monitor other physiological variables (e.g. the electroencephalogram, cardiac output monitor or spirometry) should be available.

RELATED DOCUMENTS

T1 Recommendations on Minimum Facilities for Safe Administration of Anaesthesia in Operating Suites and other Anaesthetising Locations

TE3 Policy on Supervision of Clinical Experience for Vocational Trainees in Anaesthesia

PS10 The Handover of Responsibility During an Anaesthetic

COLLEGE PROFESSIONAL DOCUMENTS

College Professional Documents are progressively being coded as follows:

TE Training and Educational

EX Examinations

PS Professional Standards

T Technical

POLICY - defined as 'a course of action adopted and pursued by the College'. These are matters coming within the authority and control of the College.

RECOMMENDATIONS - defined as 'advisable courses of action'.

GUIDELINES - defined as 'a document offering advice'. These may be clinical (in which case they will eventually be evidence-based), or non-clinical.

STATEMENTS - defined as 'a communication setting out information'.

This document is intended to apply wherever anaesthesia is administered.

This document has been prepared having regard to general circumstances, and it is the responsibility of the practitioner to have express regard to the particular circumstances of each case, and the application of this document in each case.

Professional documents are reviewed from time to time, and it is the responsibility of the practitioner to ensure that the practitioner has obtained the current version. Professional documents have been prepared having regard to the information available at the time of their preparation, and the practitioner should therefore have regard to any information, research or material which may have been published or become available subsequently.

Whilst the College endeavours to ensure that professional documents are as current as possible at the time of their preparation, it takes no responsibility for matters arising from changed circumstances or information or material which may have become available subsequently.

Promulgated (as P18): 1988

Reviewed: 1990,1995,2000

Date of current document: Feb 2006

© This document is copyright and cannot be reproduced in whole or in part without prior permission.

College Website: http://www.anzca.edu.au/