Intraoperative Monitoring and Anesthesia Record Keeping
What the exam tests
Intraoperative Monitoring and Anesthesia Record Keeping tests standards, waveform interpretation, alarm response, and legal documentation.
Core rules and concepts
- Monitor oxygenation, ventilation, circulation, and temperature. Continuous capnography is required for intubation and is the fastest detector of esophageal intubation or disconnection.
- Normal end-tidal CO2 is about 35–45 mmHg. The capnogram has inspiratory baseline, expiratory upstroke, alveolar plateau, and inspiratory downstroke.
- Pulse oximetry lags behind ventilation and is affected by poor perfusion, motion, nail polish, and dyshemoglobins.
- Non-invasive blood pressure cuff size matters; a cuff that is too small reads high. Cycle and document at intervals required by policy.
- The record is a legal document: time, drugs, doses, fluids, vital signs, events, and handovers. Late entries must be identified as late.
Worked example
End-tidal CO2 suddenly falls from 38 to 0 mmHg with a flat waveform, while the pulse oximeter is still 99%. Reasoning: the most likely causes are disconnection, esophageal intubation, circuit leak, or cardiac arrest. Check the tube and circuit first, then assess perfusion and pulse; do not wait for desaturation.
Traps
Do not rely on a single vital sign. Do not silence alarms without assessing the patient. Do not document retrospectively as if present in real time. Do not use a cuff that is too small or too large. Do not ignore a change in capnogram shape without checking the airway and circuit.