The provision of safe anaesthesia relies on the maintenance of standards of practice.
These standards include:
accreditation of anaesthetists
supervision of trainees
the use of: anaesthetic and therapeutic agents
anaesthetic equipment
patient monitors
The Australian and New Zealand College of Anaesthetists provides guidelines in these areas.
Individual anaesthetic departments are required to implement these standards taking into account the specific needs of particular locations and patient populations.
This ‘Monitoring Policy’ is based on Policy Document P18 of the Australian and New Zealand College of anaesthetists, Monitoring During Anaesthesia.
Monitoring during paediatric anaesthesia
Clinical monitoring by a vigilant anaesthetist is the basis of patient care during anaesthesia. This should be supplemented by appropriate devices to assist the anaesthetist. The anaesthetist responsible for the patient must be constantly present and may only leave after a formal hand-over to a second anaesthetist.
This department implements the recommendations of document P18 as follows.
ANZCA GUIDELINES
WCH Paediatric additions
P18.3.1 Oxygen Supply Failure Alarm
An automatically activated device to monitor oxygen supply pressure and to warn of low pressure must be fitted to the anaesthesia machine
In addition an automatically activated device to monitor oxygen pipeline pressure and warn of low pressure is provided in the operating theatres. Note: Oxygen supply failure alarms are not fitted in the induction rooms. The wall mounted machines are fitted with anti-hypoxic devices.
P18.3.2 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 the anaesthetic machine is in use.
It is placed at the fresh gas outlet of the anaesthetic machine when the paediatric anaesthetic circuit is in use (Ayre’s T piece). It is placed between the CO2 absorber and the inspiratory limb of the circle circuit when the circle circuit is in use. Note: Oxygen analysers not provided in the induction rooms. The wall mounted machines are fitted with anti-hypoxic devices.
P18.3.3 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 exclusively available for every anaesthetised patient.
The oximeter should be used for every patient following the induction of anaesthesia
P18.3.4 Alarms for Breathing System Disconnection or Ventilator Failure
When an automatic ventilator is in use, a device capable of warning promptly of a breathing system disconnection or ventilator failure must be in continuous operation. It is desirable that this device be automatically activated.
Automatic activation is regarded as essential.
P18.3.5 Electrocardiograph
Equipment to monitor and continually display the electrocardiograph must be available for every anaesthetised patient.
The electrocardiograph will be used at the discretion of the anaesthetist.
P18.3..6 Temperature Monitor
Equipment to monitor temperature continuously must be available for every anaesthetised patient.
Core temperature should be monitored during procedures of greater than one hour duration.
P18.3..7 Carbon Dioxide Monitor
A carbon dioxide monitor must be exclusively available for every intubated and ventilated patient.
The carbon dioxide monitor should be used for every intubated patient.
P18.3..8 Neuromuscular Function Monitor
Equipment to monitor neuromuscular function must be available for those patients in whom neuromuscular paralysis has been induced.
Neuromuscular function should be monitored in any patient receiving an infusion of muscle relaxant.
P18.3.9 Other Equipment
When clinically indicated, equipment to monitor other physiological variables should be available
Blood pressure should be measured at least every 5 min any case of greater than 15 minutes duration or when a major regional anaesthetic block is used.
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