techniques, this responsibility may be delegated
to trained, competent, non-physician healthcare
workers. 6 Circumstances posing a potential
hazard to the anaesthetist may arise during
certain radiology and radiologically-assisted
procedures, in which case, remote observation
and monitoring facilities must be available.
Documentation at a minimum time interval
of five minutes is recommended for heart rate,
blood pressure, peripheral oxygen saturation,
end-tidal carbon dioxide and, if anaesthetic gases
are used, end-tidal vapour concentration. There
is now a plethora of electronic anaesthetic record
systems, 7 and the uptake and use of such devices
by departments is encouraged.
Handover of patient care under anaesthesia is
an unavoidable inevitability at times, but efforts
should be kept to minimise this process. If
handover is to occur, the AAGBI recommends that
a detailed handover that follows a checklist such
as the ‘ABCDE’ 5th National Audit Project (NAP5)
anaesthesia checklist, 8 with all handovers
documented in the anaesthetic record. Included
in the handover should be a further check to
ensure adequate provision of monitors and
appropriate alarm limits are set.
In the event that a solo anaesthetist is called
to perform or assist with a critical, life-saving
procedure nearby, another anaesthetist, a trained
PA (A) or, if neither is available, a trained
anaesthetic assistant should be present to continue
patient and monitoring observation. The AAGBI
advises that departments should strive to have an
experienced anaesthetist, either consultant or
senior registrar, available to cover these potential
eventualities. On the less time-critical end of the
spectrum, adequate fatigue management 9 for solo
anaesthetists during long surgical procedures
should be planned for with the presence of
experienced anaesthetists in the theatre suite.
Anaesthetic equipment
Any item of equipment used by an anaesthetist
should be familiar and appropriately checked
prior to use. 10
Oxygen supply
Continuous monitoring of delivered gas mixtures
with an oxygen analyser should be used and must
be checked and established, with audible alarms
set to verified alarm limits.
Breathing systems
Continuous waveform carbon dioxide
concentration monitoring (capnography) is
mandatory for all unconscious patients
irrespective of location, including in patients
with tracheal tube, supraglottic airway devices,
or moderately deeply sedated patients. 11
Vapour analysers
Whenever volatile anaesthetic agents or nitrous
oxide are used, vapour analysers must be used
and end-tidal concentrations recorded.
Infusion devices
If an infusion device is to be used for any aspect
of anaesthetic care, it must be checked before
use, with appropriate infusion limits and alarm
settings verified. The device should be connected
to mains power and infusion lines connected to
an intravenous cannula should ideally be
observed throughout the duration of their use.
It is recommended that a depth of anaesthesia
monitoring device is used whenever an
anaesthetic is administered solely via the
intravenous route in combination with the use
of neuromuscular blocking drugs.
Alarms
Departmental agreement on alarm limits is
recommended, and provision, maintenance,
calibration and renewal of equipment are
institutional responsibilities. However, all alarms
should be set, reviewed and audibility checked by
the individual anaesthetist before commencing
use. Airway pressure alarms are included,
particularly when positive pressure ventilation
is to be used.
Monitor displays
The configuration of display set up should be
considered before commencing anaesthesia.
Non-invasive blood pressure (NIBP) monitors
should be set at a time interval of at least every
five minutes, with readings not remaining on
Table 1
Minimum standards of monitoring in difference anaesthetic scenarios
Pulse
NIBP
ECG
End-tidal
End-tidal
Airway
Peripheral
oximeter
CO 2 O 2 , N 2 O pressures nerve
± gases stimulator
Temper-
ature*
General anaesthesia Regional anaesthesia
without sedation
Sedation
Intrahospital transfer
Anaesthesia outside
operating theatres
*If procedure >30 minutes
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