Peri-operative monitoring for major surgery, are there clear guidelines?

ABSTRACT

The Association of Anaesthtists of Great Britain and Ireland [AAGBI] guidelines although essential, arc not detailed, especially regarding invasive monitoring and monitoring for major and/or emergency surgery. This survey was aimed at establishing a perspective of relevant common practice and giving direction towards developing appropriate guidelines. A questionnaire was answered by 16 anaesthetists that analysed the anaesthetists' awareness of the AAGBI guidelines on monitoring, as well as their own practice with regard to monitoring. The majority claimed familiarity with the AAGBI guidelines. 86.2% monitored urine output for major cases. Of those, 88.2% measured urine on an hourly basis intra-operatively. 55.5% indicated they would measure preoperative body temperature in major or emergency cases, while 5.5% would measure it routinely, and 22.2% would not measure it at all. Intra-operatively, only 1 anaesthetist [5.9%] would measure temperature routinely. Different indications were given for insertion of arterial and CVP lines, however these were not affected by ITU beds unavailability. According to these surveyed anaesthetists. 19.5% of cases were done using CVP line without an arterial line. The majority [93.8%] of the anaesthetists had not inserted a Swan Ganz Catheter in the past one year. This was attributed to unfamiliarity by 31.3%, and absence of benefits by 66.6%, while non was waiting tor evidence of benefit. No alternative to Swan Ganz Catheterisation was used according to the majority of answers, although 11.8% used Transoesophageal Echocardiography [T.O.E.] and 17.6% used L.I.D.C.O. Only 18.8% of anaesthetists had used an awareness monitor in the past, but not in WWGH. There was a big diversity in monitoring practice among different anaesthetists regarding invasive monitoring and monitoring for major surgery. This reflects the absence of clear guidelines and absence of clear benefits from some monitoring devices