Recommendations for standards of monitoring during anaesthesia and recovery 2015 : Association of Anaesthetists of Great Britain and Ireland

Abstract

SummaryThis guideline updates and replaces the 4th edition of the AAGBI Standards of Monitoring published in 2007. The aim of this document is to provide guidance on the minimum standards for physiological monitoring of any patient undergoing anaesthesia or sedation under the care of an anaesthetist. The recommendations are primarily aimed at anaesthetists practising in the United Kingdom and Ireland. Minimum standards for monitoring patients during anaesthesia and in the recovery phase are included. There is also guidance on monitoring patients undergoing sedation and also during transfer of anaesthetised or sedated patients. There are new sections discussing the role of monitoring depth of anaesthesia, neuromuscular blockade and cardiac output. The indications for end‐tidal carbon dioxide monitoring have been updated.

Laboratory evaluation of a novel anaesthesia delivery device

“…As with all anaesthesia methods, and in accordance with recommendations of the Association of Anaesthetists of Great Britain and Ireland (AAGBI) that the concentration of volatile anaesthetic agents is routinely monitored from induction through maintenance and into recovery [12], the routine use of an Figure 10 Sevoflurane output of the anaesthetic delivery device at 20°C, target output 0.5%, 1.0% and 1.5% v/v sevoflurane. Mimicking spontaneously breathing patients: fresh gas flow 6 l.min À1 oxygen, end-tidal volume 500 ml, 12 breaths.min…”

Catheter Laboratory Design, Staffing and Training

“…For procedures requiring conscious sedation (in the UK), the Association of Anaesthetists of Great Britain and Ireland (AAGBI) has issued specific guidance for how these patients should be monitored and managed in the peri-procedural environment, including the need for capnography [2]. The catheter laboratory and recovery area must therefore possess the ability to monitor end-tidal CO 2 to ensure these patients are appropriately monitored and managed.…”

Electronic anaesthesia records - a reply

“…The guideline recommends that an end-tidal oxygen fraction (FetO 2 ) of ≥ 90% is achieved before induction of anaesthesia, states that nasal oxygenation could be considered as part of a pre-oxygenation method, and suggests that the anaesthetist should consider attaching nasal cannulae with 5 l.min À1 oxygen flow before starting pre-oxygenation, to maintain bulk flow of oxygen during intubation attempts, or attach nasal oxygenation after pre-oxygenation during the apnoeic period. There is also mention of humidified high-flow nasal oxygenation, although limited data exists in pregnant women [2].…”

“…White and MathiszigLee for their comments on the AAGBI Recommendations for Standards of Monitoring (SoM) during anaesthesia and recovery [1,2]. I agree with them that anaesthetic departments in the UK and Ireland should aim to move to electronic anaesthetic record systems (EARS) in the medium to long term.…”