General Anesthesia Safety and Patient Monitoring
General Anesthesia Safety
and Patient Monitoring
The anesthetic drugs used in general anesthesia to induce unconsciousness, may cause depression of the cardiac and respiratory functions, which must be continuously monitored throughout the GA procedure.
Continuous monitoring is necessary to ensure patient safety during general anesthesia.
Patient Monitoring during General Anesthesia
The main functions monitored during general anesthesia include oxygenation, circulation, and temperature, by measuring parameters such as heart pulse and rhythm, blood pressure, oxygen saturation, and temperature level.
Breathing volume, rate and pressure are monitored by clinical observation from an anesthesia team member.
The patient’s respiratory reflexes are also lost under general anesthesia. Since the patient is not able to protect the airway on his own, it is the duty of the personnel monitoring the patient to protect him from aspiration.
For patients with existing health conditions that are at a higher risk of complications under general anesthesia, further monitoring of vital signs may be required to ensure patient’s safety.
The equipment most commonly used for general anesthesia patient monitoring includes:
- Continuous Electrocardiography (ECG or EKG): Through a set of electrodes placed on patient’s body, it monitors the electric activity of the heart, recording heart rate and rhythm,
in order to help the anaesthesiologist to identify early signs of cardiac depression or heart ischemia.
- Continuous pulse oximetry (SpO2): A device usually placed on one of the fingers that monitors oxygen saturation in the blood, and gives a warning in case of hypoxia.
Clinical evaluation of the skin or mucosa color may also give an early signal of inadequate oxygenation.
- Blood Pressure Monitor: Commonly, blood pressure is monitored by placing a blood pressure cuff around the patient's arm.
A blood pressure device takes blood pressure measurements at regular, preset intervals throughout the surgery.
- Temperature measurement: The temperature monitoring is necessary to early detect any signs of a rare but dangerous complication, known as malignant hyperthermia.
- Capnography: This device measures the concentration of carbon dioxide in the air exhaled from the lungs, to check the adequacy of ventilation.
- EEG: An electroencephalogram (EEG) is a test that measures and records the electrical activity of the brain. It may be used to verify the depth of anesthesia, and prevent cases of anesthesia awareness.
Clinical observation of sympathetic overactivity may be used when EEG is not available.
Safety measures during General Anesthesia
The introduction of strict guidelines regarding continuous patient monitoring throughout the general anesthesia procedure is believed to be the main factor
for reducing the incidents of GA related patient morbidity in the last years.
Read more about 'Possible Complications and Risks of General Anesthesia'
Due to the increased risk in procedures involving deep sedation or general anesthesia, except of the continuous monitoring,
there are additional safety requirements regarding both personnel and equipment that must be immediately available in case of an emergency.
A minimum of three (3) individuals must be present.
- An anesthesiologist or a dentist trained and qualified to administer general anesthesia.
- Two additional individuals adequately trained to provide ACLS (Advanced Cardiac Life Support).
- When the same person performs both the administration of general anesthesia and the dental procedure, one of the other team members must be designated for patient monitoring.
- A positive-pressure oxygen delivery system must be immediately available.
- Electrocardiograph (ECG)
- Equipment for advanced airway management, and Advanced Cardiac Life Support.
- Resuscitation medications.
Next page: 'Recovery from General Anesthesia'