Anaesthetic Monitoring Standards

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ANZCA Professional Standard PS41 (Anaesthetic Machine Monitoring Standards) mandates minimum monitoring for all patients undergoing general, regional, or sedation anaesthesia. Continuous monitoring: Inspired and expired oxygen (paramagnetic or fuel cell analyzer, alarm if FiO₂ <21%), airway pressure (displays peak, plateau, PEEP, mean pressures; high/low pressure alarms), expired carbon dioxide (capnography with waveform, alarm if ETCO₂ >55 mmHg or <15 mmHg or absent), and volatile agent concentration (infrared analyzer, alarm if MAC <0.3 or >1.5). Cardiovascular monitoring: ECG continuous, blood pressure (non-invasive automatic oscillometric device, 1-5 minute intervals; invasive arterial monitoring for major surgery/hemodynamic instability), pulse oximetry continuous (alarm if SpO₂ <90%). Temperature monitoring: Mandatory for procedures >30 minutes, expected temperature change, or pediatric patients; sites include nasopharyngeal, esophageal, tympanic, bladder, skin. Neuromuscular monitoring: Required when NMBA used (train-of-four, double-burst stimulation, tetanus, post-tetanic count), ideally at adductor pollicis or orbicularis oculi. Depth of anaesthesia: BIS (40-60 for general), entropy (SE 40-60, RE 40-60) recommended for TIVA or high-risk patients. Documentation: All monitored parameters recorded at regular intervals (minimum every 15 minutes), alarm limits set appropriately, all alarms audible and visible. Alarms: Must be enabled and set appropriately for each patient; never disabled permanently. Invasive monitoring: Arterial line (continuous BP, frequent ABG), CVP ( preload assessment, drug administration), PA catheter (mixed venous oxygen, wedge pressure), PiCCO (cardiac output, stroke volume variation) for complex cases. [1-10]