Monitoring Selama Anestesi

Ainul Rofik
FK Unusa
Assalamu’alaikum wr. wb.
 Pendahuluan
• Pasien yg dianestesi harus dimonitoring secara
ketat
• Obat anestesi mempengaruhi CNS/SSP, sistem
cardiovascular, dan sistem pernapasan (jalan
napas & paru)
• Anestesia menekan banyak fungsi autonomic
normal tubuh (pernapasan, detak jantung,
tekanan darah & fungsi lainnya)
 Definisi
• interpret available clinical data to help
recognize present or future mishaps or
unfavorable system conditions.
• not restricted to anesthesia (change “clinical
data” above to “system data” to apply to
aircraft and nuclear power plants)
 What is monitoring
• Physiologic parameter & Patient safety
parameter
• Clinical skills & Monitoring equipment
• Data collection, interpretation, evaluation,
decision
• Problem seeking, Severity assessment,
Therapeutic assessment, Evaluation of
Anesthetic interventions
 What is monitoring
• Patient & equipment monitoring dipakai utk :
– Titrasi pemberian obat anestesi
– Mendeteksi keraguan perubahan fisiologis
– Memungkinkan intervensi dilakukan sblm pasien
dalam bahaya
– Mendeteksi dan membetulkan kerusakan alat
(equipment malfunction).
 Patient monitoring & management
• Things you measure (physiological measurement,
such as BP or HR)
• Things you observe (e.g. observation of pupils)
• Planning to avoid trouble (e.g. planning induction
of anesthesia or planning extubation)
• Inferring diagnoses (e.g. unilateral air entry may
mean endobronchial intubation)
• Planning to get out of trouble (e.g. differential
diagnosis and response algorithm formulation)
 Level of monitoring
• Routine
• Specialize
• Extensive Non-equipment
• Non-invasive
• Minimally invasive
• Penetrating / Invasive / Highly invasive Systematic
Respiratory
• Cardiovascular
• Temperature
• FetalNeurological
• Neuro-muscular
• Volume status & RenalStandards for basic intraoperative
monitoring( ASA)
 Standard ASA
• pulse oximeter
• Electrocardiography
• noninvasive blood pressure device
• temperature monitor
• In addition :
– end tidal carbon dioxide
– inspired oxygen concentration
– the use of low oxygen concentration
– ventilator disconnect alarms
– Quantitative monitoring of the volume of expired gas
 Standard ASA
• Continual monitoring :
– measurement repeated regularly and frequently in
steady, rapid succession (eg, automatic noninvasive
blood pressure measurement), whereas continuous
monitoring is that which is prolonged, without
interruption (eg, ECG monitoring).
• the most important monitor is the presence of
an anesthesia clinician throughout anesthesia
 Alat yg sering dipakai
• Manset tekanan darah
– Biasanya melingkari lengan atas.
• Pulse oximeter
– Mengukur kadar oksigen dlm darah (diletakkan pada
ujung jari / earlobe)
• ECG
– Monitor aktivitas jantung (kabel leads diletakkan di
dada dg electrode)
• Probe suhu
– Diletakkan pada kulit (eksternal)
– Dimasukkan ke esophagus melalui mulut (internal)
• Oxygen analyzer and carbon dioxide analyzer
– Pada mesin anestesi
 Clinical monitoring
• Using visual inspection, auscultation, and
palpation is a primary determinant of patient
safety.
• Changes in clinical signs may be subtle, and
often precede abnormalities in parameters
measured by monitoring devices.
• Monitoring devices do not replace clinical
observation; rather, they amplify and quantify
clinical information
 Cardiovascular monitoring
• Non-invasive :
– blood pressure ( NIBP )
– Electrocardiography ( ECG )
• Advanced monitoring :
– Direct arterial blood pressure
– Cardiac filling pressure monitor
– Central venous pressure
– Pulmonary capillary wedge pressure
 Respiratory monitoring
• Ventilatory monitoring :
– Rate
– Rhythm
– volume of respiration
– Auscultation: precordial, esophageal stethoscope
– Palpation: reservoir bag movement
– Monitoring devices : capnometer (end-tidal CO2
analysis), Spirometer, Airway pressure
manometer, Circuit disconnection alarm
 Respiratory monitoring
• Oxygenation monitoring :
– Direct observation: impaired mental function,
sympathetic overactivities, appearance(+
cyanosis)
– Auscultation: wheezing, crepitation
– Monitoring devices : Arterial blood gas analysis,
Percutaneous O2 measurement, Pulse oximeter
(Percent of oxyhemoglobin / total hemoglobin)
 Machine & circuit monitoring
• Safety system :
– DISS
– PISS
– Quick disconnection adaptor
– Oxygen fail-safe valve
– Oxygen supply failure alarm
• Oxygen analyzer
• Airway gas composition
• Clinical skills: flowmeters, vaporizers
• Monitoring devices: Infrared spectrometer
 Depth of anesthesia
• eye signs
• respiratory signs
• cardiovascular signs
• CNS signs
• EEG monitoring
• Facial EMG monitoring (experimental)
• Esophageal contractility (obsolete)
 Neurologic monitoring
• Depth of anesthesia ( BIS )
• EEG
• Evoked potentials
• Cerebral blood flow
• Intracranial pressure
 Neuromuscular monitoring
• Clinical skills
• Monitoring device :PERIPHERAL NERVE
STIMULATOR
 Volume status & renal monitoring
• Estimate blood loss
• Urine output
• Hemodynamic stability
 Electrolyte/metabolic monitoring
• Fluid balance
• Sugar
• Electrolytes
• Acid-base balance
 Coagulation monitoring
• PT
• PTT
• INRACT
• Platelet counts
• Factor assays
• TEG
• Clinical sign
 Temperature monitoring
• 4 mechanism of heat loss
• Perioperative hypothermia (BT<36)
• Core temperature :
– Nasopharynx
– Esophageal
– tympanic membrane
– pulmonary a. Catheter
– Bladder
– rectum
 Temperature monitoring
• Rationale for use :
– detect/prevent hypothermia
– monitor deliberate hypothermia
– adjunct to diagnosing MH
– monitoring CPB cooling/rewarming
 Temperature monitoring
• Deleterious effects of hypothermia :
– cardiac dysrhythmia
– increased PVR
– Lt. shift of the Oxygen-hemoglobin dissociation curve
– reversible coagulopathy (platelet dysfunction)
– postoperative protein catabolism and stress response
– altered mental status
– impaired renal function
– decreased drug metabolism
– poor wound healing
 Alat monitoring invasif
• Tergantung pada :
– Kondisi pasien
– Prosedur pembedahan
– Tipe anestesi
• Dimasukkan ke dalam tubuh
– Kateter urine
– Vena/arteri kateter
– TEE (transesophageal echocardiograph)
• Dipasang di OK / setelah pasien dianestesi
Wassalamu’alaikum wr. wb.