General anesthesia
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In modern medical practice, general anaesthesia is a complex procedure involving:
Preaneasthetic evaluation
Monitoring
Monitoring involves the use of several technologies to allow for a controlled induction of anaesthesia, maintenance and emergence from anaesthesia.
There are different guidelines concerning monitoring during anaesthesia, illustrated by the recommendations:
1. Continuous electrocardiography (ECG) - placement of electrodes which monitor heart rate and rhythm, as well as showing evidence of other cardiac pathologies (e.g. ischaemic heart disease).
2. Continuous pulse oximetry (SpO2) - Allows early detection of cyanosis and a fall in patients' blood oxygen tension.
3. Blood pressure Monitoring (NIBP or IBP) - Generally non-invasive methods of measuring blood pressure such as a dinamap(TM) or machine which continuously checks blood pressure non-invasively. Alternatively, for major surgery such as cardiac surgery, anaethetists may use invasive monitoring with an arterial cannula.
4. Agent concentration measurement - Common anaesthetic machines have meters to measure the percent of inhalational anaesthetic agent used (e.g. sevoflurane, isoflurane, desflurane, halothane etc).
5. Low oxygen alarm - Almost all circuits have a backup alarm in case the oxygen delivery to the patient becomes compromised. This warns if the fraction of inspired oxygen drops lower than room air (21%) and allows the anaethetist to take immediate remedial action.
6. Circuit disconnect alarm - indicates failure of circuit to achieve a given pressure during mechanical ventilation.
7. Carbon dioxide measurement (Intraoperative awareness
