HHE Theatre and surgery supplement 2018 | Page 20

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

General anaesthesia

Regional anaesthesia without sedation

Sedation

Intrahospital transfer

Anaesthesia outside operating theatres

* If procedure > 30 minutes

20 HHE 2018 | hospitalhealthcare . com