Office Anesthesia Monitoring

Abstract

SUMMARY It is universally agreed that no electronic device could ever replace human vigilance or knowledge in maintenance of high-quality anesthesia care. Nevertheless, it is accepted practice that all patients be monitored continually when anesthetic agents are employed. The American Society of Anesthesiologists' standards for basic intraoperative monitoring include the presence of qualified anesthesia personnel throughout the conduct of all general anesthetics, regional anesthetics, and monitored anesthesia care and continual evaluation of the patient's oxygenation, ventilation, circulation, and temperature during all anesthetics. The Committee on Anesthesia of the AAOMS has chosen not to dictate monitoring techniques, nor has it chosen to set a “standard of practice” for monitoring.1 The Committee does, however, suggest guidelines that parallel the standards established by the ASA. Surgeons accept monitoring as part of routine office surgery. This monitoring at the very least includes recording of blood pressures, respiratory rate, and heart rate, which at times is more qualitative than quantitative. Today we do not have ideal mechanical monitoring devices but rather devices that accu-rately measure and record a patient's vital functions automatically at brief intervals. Literally hundreds of devices exist in the marketplace, quality and cost spanning a wide range. Required equipment includes (1) noninvasive blood pressure device, (2) ECG and defibrillator, (3) pulse oximeter, and (4) temperature recording device. Coexistent with the use of more sophisticated devices is the necessity to understand how they work and what parameters require intervention. Finally, what will the near future hold? Most likely capnography will be applied to the sedated patient via a nasal prong device to give us a more instantaneous evaluation of hypoventilation. As we advance through the 1990s, standardization will lead to better patient outcomes and probably reductions in malpractice premiums as experienced by anesthesiologists in the 1980s. As has been pointed out in an editorial by Laskin,6 we have a very long and safe history of practicing ambulatory anesthesia in our office surgical practices. We can only expect this to get better.