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Clinical monitoring

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Clinical monitoring of the depth of anaesthesia relies on the presence of autonomic reflexes:

  • ophthalmic:
    • pupil size, reducing with increasing depth, but may dilate in very deep anaesthesia
    • opioids and anticholinergics alter pupil size by a central action and so make this index less valid
  • cardiovascular:
    • the trend in heart rate and arterial blood pressure is followed
    • it may be modified by drugs, haemorrhage and body fluid abnormalities
  • respiratory:
    • the trend in rate, depth and rhythmicity of breathing
    • effect of ventilation
    • hiccuping or bronchospasm may indicate light anaesthesia
  • skin:
    • sweating can be a sign of light anaesthesia; reduced by anticholinergic agents
    • colour; good perfusion indicated by pink hue
    • capillary refill time; an indirect index of tissue perfusion
    • temperature; particularly important in infants

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