Monitoring, Equipment, and Patient Safety
Core concepts
Understand the standards for basic anesthetic monitoring: continuous presence of an anesthesia professional, pulse oximetry, capnography, electrocardiography, blood pressure, and temperature. Know the principles and limitations of each monitor and the common sources of artifact. Understand the equipment check, including the anesthesia machine, breathing circuit, and suction. Know the presentation and management of equipment failure and alarm fatigue. Recognize the importance of the WHO surgical safety checklist, hand hygiene, and medication safety. Understand the principles of closed claims analysis and how human factors contribute to adverse events.
Traps in questions
- Relying on a single monitor; pulse oximetry can be normal in the presence of hypoventilation if oxygen is supplemented.
- Forgetting that capnography is the standard for confirming and monitoring tracheal intubation.
- Overlooking that a machine check must include the vaporizer, circuit, and scavenging system.
- Assuming an alarm always indicates a patient problem; check the sensor and connection first.
- Missing that the surgical safety checklist reduces morbidity and mortality when used properly.
Worked example / rule of thumb
A patient with a normal oxygen saturation but rising end-tidal CO2 and a falling respiratory rate may be hypoventilating; capnography reveals what oximetry misses. Rule of thumb: when an alarm sounds, check the patient first, then the equipment, then the monitor.
Exam framing
Questions often test which monitor detects a specific complication earliest. Capnography detects esophageal intubation and disconnection; pulse oximetry lags behind hypoxemia.