Importance of Patient Monitoring

There are several reasons why patient monitoring during surgery is important:

1. Tracking and prevention of intraoperative awareness and free recall
The widespread use of muscle relaxants makes the job of the anesthesiologist more difficult in determining levels of consciousness, and there is an increased potential for awareness and recall in the absence of a direct measure.  Because of the patient’s inability to move, speak, or even open their eyes, patients rendered paralyzed by muscle relaxants appear to be unconscious regardless of their true state of consciousness.  Anesthesiologists must infer a patient’s state of consciousness from indirect variables such as drug dosages and changes in vital signs such as heart rate and blood pressure.

2. Improved timing
The use of consciousness monitoring would enable the anesthesiologist to administer muscle relaxants and perform procedures such as endotrachael intubation at times when the patient is at an appropriate level of consciousness.

3. Drug delivery tailored to individual needs
Drug levels can be adjusted in response to changes in surgical stimulation as well as individual variation.  Monitoring also enables more precise and safer use of the newest drugs that have increasingly shorter half-lives.

4. Reduce patient overmedication
Precision drug dosing can increase patient safety.  However, in the absence of monitoring, anesthesiologists generally try to err on the side of overmedication. Monitoring allows the anesthesia provider to administer less medication while ensuring that patients are maintained at the proper level of sedation at all times.  The practice of bringing patients “deeper” than necessary is costly in many ways.  First, it uses more drugs and agents than necessary, which ultimately adds to the cost of surgeries.  Over-medication contributes to patient risk, especially for those patients who are already physically debilitated or compromised prior to surgery.  Over-medication also leads to slower arousal following surgery, which can add to the indirect cost of surgery.