Monitoring During Endoscopy
Nov 11, 2024Keep your finger on the pulse - monitoring for endoscopy π©Ίπ‘
Clinical observation and monitoring is the backbone of safe patient care during anaesthesia, forming a standardised practice that can be tailored to suit the individual needs of the patient and procedural requirements. π§βοΈπ©βοΈ
At a minimum, all patients undergoing general anaesthesia or sedation should have the following monitoring applied:
π‘οΈ Pulse oximetry - when in use, the variable pulse tone and low threshold alarm should be set to a volume audible to the practitioner responsible for anaesthesia. π
π Intermittent non-invasive blood pressure - the interval of measurement will be variable between patients depending on their condition, but at a minimum should cycle no less than every 10 minutes. β±οΈ
π Electrocardiograph (ECG) - should be available for every anaesthetised patient. It should also be used for every patient undergoing regional anaesthesia.
For patients undergoing general anaesthesia, additional monitoring including oxygen analysis π₯, end tidal Carbon dioxide (etCO2) π¬οΈ and inhalational anaesthetic agent monitoring (where applicable) should be in use.
For patients receiving sedation, etCO2 monitoring should be immediately available for use for every patient.
All patients receiving sedation should have oxygen therapy π¨ applied at its commencement, with close ongoing observation π. Oxygen therapy helps to prevent hypoxia, however, it can mask hypoventilation, so patients receiving deep sedation or who are deemed to be high risk β οΈ should have etCO2 continuous waveform monitoring applied as well.
In the endoscopy suite π₯, most patients are receiving sedation to facilitate their procedure, with variable and rapidly changing levels of sedation encountered. Regular communication π£οΈ with these patients is essential to gauge their level of sedation and provide them with reassurance. π€
It is important to note that once verbal communication with a patient is lost, the patient then requires the same level of care and monitoring as for general anaesthesia. π¨
Monitoring forms part of the overall patient assessment π, bearing in mind it is subject to error and malfunction β οΈ, and does not replace the most important pieces of monitoring you have - your eyes π and critical thinking! π€
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References:
ANZCA PS18 (2017) Anaesthesia Monitoring. https://www.anzca.edu.au/getattachment/0c2d9717-fa82-4507-a3d6-3533d8fa844d/PS18-Guideline-on-monitoring-during-anaesthesia
Blayney, M.R. (2012) Procedural sedation for adult patients: an overview. Continuing Education in Anaesthesia Critical Care & Pain, Vol. 12(4) Pp 176–180, https://doi.org/10.1093/bjaceaccp/mks016
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