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The Physics, Clinical Measurement and Equipment of Anaesthetic Practice for the FRCA$
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Patrick Magee and Mark Tooley

Print publication date: 2011

Print ISBN-13: 9780199595150

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780199595150.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 17 June 2021

Principles and Standards of Anaesthetic Monitoring

Principles and Standards of Anaesthetic Monitoring

Chapter 11 Principles and Standards of Anaesthetic Monitoring
The Physics, Clinical Measurement and Equipment of Anaesthetic Practice for the FRCA

Patrick Magee

Mark Tooley

Oxford University Press

The World Federation of Societies of Anaesthesiology (WFSA) adopted standards relating to the safe practice of anaesthesia in 1992 and such standards had already been proposed by a number of countries in order to cut the morbidity due to anaesthesia itself. In the modern era it is easy to forget that historically anaesthesia and surgery did indeed have associated morbidity and mortality and there was very little assistance from technology to monitor patients. The evolution of these standards is based on two main requirements of monitoring. The first is to record anticipated deviations from normal values, which require accurate measurement to ensure patient safety. The second is to warn of unexpected, life-threatening events that, by definition, occur without warning, and could affect the fit, young patient as easily as the old and infirm. All international standards stress the importance of the continual presence of a fully trained and accredited anaesthetic person, and one Australian study demonstrated that many mishaps occur in the absence of such a person [Runciman 1988]. This applies to general and regional anaesthesia, sedation and recovery. Because perceptions of safety and standards vary throughout the world, despite the presence of an International Standards Organisation, debate about the minimum requirements for monitoring continue. Central to the maintenance of these standards is the quality of persons entering the specialty, the quality of training programmes, and the continuing education of specialists throughout a professional lifetime [Sykes 1992]. It is difficult to determine with certainty the effect that additional technological monitoring has on safety. One clear example is the inability of the trained human eye to detect cyanosis, this human failure occurring maximally at 81–85% oxygen saturation. Clearly, the pulse oximeter has improved the quality of cyanosis detection. Numerous studies all over the world have shown that mortality due to anaesthesia itself fell significantly between the 1950s and the 1980s, by which time extensive technological monitoring was being introduced, and training programmes had been very much improved. Utting [1987] reviewed 750 cases of death and cerebral damage reported to the British General Medical Council between 1970 and 1982 that were thought to be the result of errors in technique.

Keywords:   airway monitoring, alarm devices, arterial blood pressure monitoring, bispectral index (BIS) monitors, blood pressure monitoring, capnographs, carbon dioxide monitoring, circulation monitoring, disconnection alarms, heat loss minimisation, intra-arterial blood pressure monitoring, malignant hyperthermia, peripheral nerve stimulators, postanaesthesia care, temperature monitoring, tissue perfusion monitoring, ventilation monitoring

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