Patient monitoring involves both non-instrumental and instrumental methods. Non-instrumental monitoring includes clinical observation of a patient's appearance, breathing, bleeding, and positioning. Instrumental monitoring provides data through devices like ECGs, which measure heart rate and rhythm, blood pressure cuffs, pulse oximeters, capnography, and temperature monitors. Direct arterial blood pressure monitoring via an intra-arterial catheter provides continuous, beat-to-beat pressure readings but carries risks like infection, while noninvasive blood pressure methods take intermittent readings and avoid invasiveness. Together, non-instrumental observation and instrumental monitoring devices provide clinicians vital information to care for patients.

1. Patient Monitoring
Patient monitoring and the equipment to
support it are vital to caring for patients
in operating rooms, intensive care units,
emergency departments, and in acute care
settings

2. :Patient Monitoring divided into
• Non Instrumental: clinical observation
(“look, listen, feel”)
Visual and auditory surveillance is central to
patient monitoring, and involves many
dimensions:
• Observing the patient’s color, respiratory
pattern, accessory muscle use, and
looking for movements, grimaces or
unsafe patient positioning

3. • Observing the patient’s clinical data on
intraoperative monitors
• Observing bleeding and coagulation at the
surgical site (e.g., are the surgeons using many
sponges or are they doing a lot of suctioning?)
• Monitoring the functioning of all lines to ensure
that IV catheters have not infiltrated
• Conducting an anesthesia machine and
workspace checkout

4. • Pulse: rate, volume, rhythm------etc
• Capillary refilling
• Sweating

5. Instrumental patient monitoring
• Electrocardiogram (Provides information about
rate, rhythm, ischemia (ST Segments))
• Blood pressure (manual, automatic, arterial
catheter)
• Pulse oximeter (usually on fingertip or ear lobe)
• Capnograph (especially in patients with an
LMA or ETT)
• Oxygen analyzer (part of anesthesia machine)
• Anesthetic agent concentration analyzer

6. 7. Temperature (usually esophageal or axillary)
8. Precordial or esophageal stethoscope (Listen to
heart sounds, breath sounds)
9. Gas flows/ spirometry (part of anesthesia
machine)
10. Airway pressure monitor (part of anesthesia
machine)
11. Airway disconnect alarm (part of anesthesia
machine)
12. Peripheral nerve stimulator (where
appropriate)
13. Urometer (measure urine output where
appropriate)

7. Electrocardiogram ECG
This provides the clinician with three types of
information: (1) heart rate, (2) cardiac rhythm
(3) information about possible myocardial
ischemia (via ST segment analysis) In addition,
ECG monitoring can help assess the function of
a cardiac pacemaker
The most common electrocardiographic system
used during anesthesia is a 5-electrode lead
system. This arrangement allows for the
recording of any of the six limb leads plus a
single precordial (V) lead

9. Blood Pressure
Measurement of arterial blood pressure is an
important indicator of the adequacy of circulation
Systemic blood pressure monitoring is
commonly performed indirectly using extremity-
encircling cuffs or directly by inserting a catheter
into an artery and transducing the arterial
pressure trace.
Variety of techniques available for measuring
changes in systolic, diastolic, and mean arterial
pressure (MAP).

10. Indirect Measurement of Arterial
Blood Pressure
The simplest method of blood pressure
determination estimates systolic blood
pressure by palpating the return of the
arterial pulse while an occluding cuff is
deflated. Modifications of this technique
include the observance of the return of
Doppler sounds, the transduced arterial
pressure trace, or a
photoplethysmographic pulse wave as
produced by a pulse oximeter.

11. • Auscultation of the Korotkoff sounds
permit estimation of both systolic (SP) and
diastolic (DP)
• blood pressures. MAP can be calculated
using an estimating equation (MAP = DP +
1/3 [SP-DP]).

12. • The American Heart Association recommends
that the bladder width for indirect blood pressure
monitoring should approximate 40% of the
circumference of the extremity.
• Bladder length should be sufficient to encircle at
least 60% of the extremity.
• Falsely high estimates result when cuffs are too
small, when cuffs are applied too loosely, or
when the extremity is below heart level.
• Falsely low estimates result when cuffs are too
large, when the extremity is above heart level, or
after quick deflations.

13. Automated Intermittent
Technique
Many limitations of manual intermittent blood
pressure measurement have been overcome by
automated NIBP devices, which are now used
widely. In addition, automated NIBP devices
provide audible alarms and can transfer data to
a computerized information system. However,
the greatest advantage of automated NIBP
devices over manual methods of blood pressure
measurement is that they provide frequent,
regular blood pressure measurements and free
the operator to perform other vital clinical duties.

14. • In a generic noninvasive oscillometric
monitor (noninvasive blood pressure, or
NIBP),
• Cuff pressure is sensed by a pressure
transducer whose output is digitized for
processing.
• After the cuff is inflated by an air pump,
cuff pressure is held constant while
oscillations are sampled.

17. Direct method (intra-arterial pressure
(monitoring
Intra-arterial pressure monitoring provides
an invasive, continuous measure of blood
pressure by beat-to-beat
reproduction of the arterial pressure
waveform

18. The method requires the insertion of a short
parallel-sided cannula into an artery.
A continuous flow of either saline or
heparinised saline at rates between 1 and
4 ml per hour is used to reduce clot
formation in the cannula.
The cannula is connected by a short length
of narrow-bore, noncompliant
plastic tubing containing saline to a pressure
transducer

19. Indications for Arterial
Cannulation
1. Continuous, real-time blood pressure
monitoring
2. Planned pharmacologic or mechanical
cardiovascular manipulation
3. Repeated blood sampling
4. Failure of indirect arterial blood pressure
measurement
5. Supplementary diagnostic information from the
arterial waveform
6. Determination of volume responsiveness from
systolic pressure or pulse pressure variation

20. Hazards of Arterial Cannulation