Patient monitoring during anaesthesia

Nadzor, promatranje (engl. monitoring) obuhvaća praćenje bolesnikova stanja prije anestezije, tijekom anestezije i nakon nje. Područje monitoringa za vrijeme anestezije odnosi se na praćenje bolesnikovih vitalnih funkcija, promatranje anestezijskog stroja i ventilatora. U monitoring se ubraja: motrenje stanja svijesti (prije uvoda u samu anesteziju, monitoring pri dubini anestezije i stanja nakon završetka anestezije), krvnog tlaka, frekvencije srca i kvalitete perifernog pulsa, EKG, frekvencije disanja i volumena disanja, zasićenost periferne krvi kisikom, tjelesna temperatura, vrijednosti ugljikovog dioksida u izdahnutoj smjesi plinova, odreĎuje se razina neuromišićnog bloka (ukoliko je primjenjen neuromišićni relaksator), prati se diureza (kada je to indicirano). TakoĎer, monitoriraju se inspiracijske i ekspiracijske koncentracije hlapljivog anestetika. U posebnim slučajevima prati se razina središnjeg venskog tlaka (SVT), minutnog volumena srca, tlak u plućnoj arteriji, doplerska ehokardiografija, razina intrakranijalnog tlaka, elektroencefalografija (EEG), te količina izgubljene krvi.Preporuka je koristiti se neinvazivnim metodama monitoringa, a ukoliko to situacija zahtijeva, uključuje se i invazivni nadzor. Završnim će se radom obuhvatiti i plan zdravstvene skrbi kroz sestrinske dijagnoze, ciljeve i intervencije.Patient control and observation during anaesthesia includes patient's condition before anaesthesia, during and following anaesthesia. Monitoring during anaesthesia refers to monitoring of the patient's vital signs, observation of anaesthesia machine and ventilator. The monitoring includes as follows: the state of consciousness (before the anaesthesia induction, the depth of anaesthesia and the patient state during recovery following anaesthesia), vital signs such as blood pressure, heart rate and quality of peripheral pulse, electroencephalography (ECG), respiratory rate and volume of breathing, oxygen saturation of peripheral blood, body temperature, diuresis (when indicated). Further, patient monitoring includes the value of carbon dioxide in the expired gas mixture, the level of neuromuscular blockade (if the neuromuscular relaxant is used), as well as monitor of the inspiratory and expiratory concentrations of volatile anesthetics. In special cases, values of the central venous pressure (CVP), cardiac output, blood pressure in the pulmonary artery, doppler echocardiography, the values of intracranial pressure, electroencephalography (EEG), and the amount of blood lost. It is recommended to use non-invasive monitoring but invasive monitoring is possible if needed. Final work will include a plan of health care through the nursing diagnoses, objectives and nursing interventions