Managing Blood Gas Levels During Procedures with Inhaled Anesthetics

Essential Monitoring Requirements

The American Society of Anesthesiologists recommends that all patients undergoing inhaled anesthesia require continuous monitoring of inspired and expired oxygen levels and waveform capnography 1, 2
Inspired and end-tidal inhalational anesthetic drug concentration monitoring is mandatory when using volatile anesthetics, as stated by the American Society of Anesthesiologists 1, 3
Airway pressure, tidal volume, and respiratory rate must be continuously monitored during mechanical ventilation, according to the American Society of Anesthesiologists 1
Pulse oximetry with plethysmograph, non-invasive blood pressure (NIBP), ECG, and temperature monitoring are minimum requirements for all anesthetic procedures, as recommended by the American Society of Anesthesiologists 1, 4

The American Society of Anesthesiologists advises verifying all anesthetic equipment is functioning properly before use, including gas analyzers and monitors 5, 6
A "two-bag test" should be performed to check the integrity of the breathing system, vaporizers, and ventilator, as recommended by the American Society of Anesthesiologists 5, 7
Gas sampling lines should be properly attached and free from obstruction to prevent inaccurate readings, according to the American Society of Anesthesiologists 5
All alarms should be set to appropriate values and enabled before beginning the procedure, as stated by the American Society of Anesthesiologists 1, 2

Modern anesthesia workstations have mandatory hypoxic mixture protection and inspired oxygen measurement features, as recommended by the American Society of Anesthesiologists 1, 3
Inspired and expired oxygen levels should be monitored continuously throughout the procedure, according to the American Society of Anesthesiologists 1

Waveform capnography is essential for monitoring end-tidal CO2 and respiratory patterns, as stated by the American Society of Anesthesiologists 1, 8
Ventilation parameters should be adjusted based on capnography readings to maintain appropriate CO2 levels, according to the American Society of Anesthesiologists 1

Appropriate alarm limits for all monitors should be set and enabled, as recommended by the American Society of Anesthesiologists 1, 2
Alarm defaults should be standardized within departments to improve safety, according to the American Society of Anesthesiologists 1
"Smart alarms" with algorithms to assess alarm priority should be considered when available, as stated by the American Society of Anesthesiologists 1

Gas monitoring lines can cause significant leaks if not properly attached; connections should be checked carefully, as advised by the American Society of Anesthesiologists 5, 6
Failure to monitor end-tidal anesthetic concentration can lead to awareness or overdose; continuous monitoring should be maintained throughout the procedure, according to the American Society of Anesthesiologists 1, 8