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Monitoring in Anesthesia

Dr.Arkan Jaafar , M.D. Anesthesiologist ,Medical college of Mosul

OXYGENATION

Oxygenation is monitored clinically by providing adequate illumination of the patient's color and by pulse oximetry pulse oximeter measure : 1. The oxygen saturation of haemoglobin in arterial blood - which is a measure of the average amount of oxygen bound to each haemoglobin molecule. The percentage saturation is given as a digital readout together with an audible signal varying in pitch depending on the oxygen saturation 2. The pulse rate - in beats per minute .

VENTILATION

Ventilation is monitored clinically by verification of a correctly positioned endotracheal tube as well as by observing chest excursions, reservoir bag displacement, and breath sounds over both lung fields. Ventilation is quantitatively monitored using end tidal carbon dioxide (ETCO2) analysis as well as an audible disconnection alarm on all mechanically ventilated patients

CIRCULATION

palpation of the pulse auscultation of heart sounds Blood pressure measurement : -Automated non-invasive BP measurements NIBP -lnvasive BP monitoring :The radial artery at the wrist is the most common site for an arterial catheter insertion. The femoral, brachial, and dorsalis pedis arteries are alternative sites A central venous pressure (CVP) catheter provides an estimate of the right atrial and right ventricular pressures. The CVP reflects the patients blood volume, venous tone, and right ventricular performance. CVP 1 - 10 mmHg

Electrocardiogram (ECG) The ECG monitors the conduction of electrical impulses through the heart. It is used to determine the heart rate and to detect and diagnose arrhythmias, myocardial ischemia, pacemaker function, and electrolyte abnormalities

Temperature : - Core temperature: measured through tympanic membrane, nasopharynx, esophagus,rectal , urinary bladder , pulmonary artery. - Peripheral temperature Urinary output : should be monitored hourly Oliguria:- urinary output <0.5 ml/kg/h Peripheral nerve stimulator : Monitoring neuromuscular function of patient receiving neuromuscular blocking agent

Arterial Blood Gas Interpretation ABG

Acid- base disturbances are indicators of serious underlying pathology Arterial blood gas examination is a useful investigation in patients with suspected respiratory or metabolic disease serial blood gas investigation can monitor the progress or treatment of the underlying disease. PH is the negative log of the H+ ion concentration PH is important because H+ ions react highly with cellular proteins resulting in alterations in their function. Therefore, avoiding acidemia and alkalemia by tightly regulating [H+] is essential for normal cellular function


Blood samples : Radial artery Brachial a. Axillary a. Dorsalis pedis a. Femoral a

ABG provides an assessment of the following: Oxygenation (PaO2 , O2 saturation). The PaO2 is the amount of oxygen dissolved in the blood and therefore provides initial information on the efficiency of oxygenation. Ventilation (PaCO2). The adequacy of ventilation is inversely proportional to the PaCO2, so that when ventilation increases, PaCO2 decreases, and when ventilation decreases, PaCO2 increases. Acid-base status (pH, HCO3, and base deficit).

The Terms

ACIDSAcidemiaAcidosis ↓ PHRespiratory CO2Metabolic HCO3 BASESAlkalemiaAlkalosis↑ PHRespiratory CO2Metabolic HCO3

ABG
PH → 7.35 – 7.45PaCO2 → 35 – 45 mmHgHCO3 → 22 – 26 mEq/LBE → - 2 ─ +2PaO2 → 80 – 100 mmHg (at sea level , FiO2 = 21%)SaO2 → 93 – 98%




رفعت المحاضرة من قبل: Abdalmalik Abdullateef
المشاهدات: لقد قام 6 أعضاء و 84 زائراً بقراءة هذه المحاضرة








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