MONITORING STANDARDS

Anaesthesia is a vital component of basic health care and merits an appropriate share of available resources. Monitoring is essential in anaesthetic practice to safeguard quality and to prevent untoward incidents. Developed nations have their own specific standards of monitoring

The Indian Society of Anaesthesiologists (ISA), taking guidelines from the WFSA and subsequent to wider deliberations in different forums, promulgate monitoring standards for anaesthesia with immediate effect. These standards are applicable for Anaesthetic service in any part of the Indian Union in any sector.

The ISA authorise these standards as National Monitoring Standards.

Standards are readout as

PRE-REQUISITES

Are essential for improvement of the functional quality of service and are needed to function.

BASIC STANDARDS

Are vital standards which are needed at any place for any pre-planned anaesthetic service.

DESIRABLE STANDARDS

The Institutions which do not have these facilities should be persuaded to acquire the same at the earliest

PRE-REQUISITES

	1.	Professional Status Only qualified Anaesthesiologists are permitted to administer anaesthesia.
	2.	Facilities and Equipments Resuscitation equipment conforming to National standards must be available in the workplace in adequate quantity / quality.
	3.	Professional Organization Appropriate 'Anaesthesia Forums' may be established and will form links with the needed Authority for Training, Certification and Accreditation. Institutional, Regional or National Protocols on Anaesthesia practices may be instituted and facilities for updating of knowledge may be ensured to improve quality.
	4.	Records and Statistics A record of details and course of each Anaesthesia procedure should be made and preserved along with the patients medical record.
	5.	Personnel and Workload Sufficient number of trained Anaesthesiologists should be available at major Hospitals and the workload should be distributed so as to avoid over or under utilisation. The Anaesthetist should take the responsibility for the transport of the patient to post-anaesthesia recovery area as well as for later consultation if needed until the patient makes adequate recovery from Anaesthesia.

BASIC STANDARDS OF MONITORING

	1.	Pre-anaesthetic evaluation and adherence to a protocol is mandatory. Service should be administered by qualified Anaesthesiologist possessing registration in modern medicine.
	2.	Availability of resuscitation equipment, uninterrupted supply of oxygen and minimum Anaestheisia equipment should be confirmed before starting the procedure.
	3.	Clinical Monitoring of colour and pulse should be done every 5 minutes during conduct of Anaesthesia.
	4.	A light source should be available always.
	5.	Stethoscope, BP apparatus and Thermometer should be available. Basal recording should be made before the start of procedure.
	6.	Cardioscope with Defibrillator capable of displaying the rate and wave pattern should be available.

DESIRABLE STANDARDS (ESSENTIAL STANDARDS FOR HIGHER SURGICAL WORKS)

	1.	All basic standards detailed above should be met with.
	2.	Anaesthetic machine and equipment used should have failure warning facility as well as check list for failure correction. Every operating Theatre should have at least one operable Anaesthestitic machine.
	3.	Periodically calibrated vaporiser (Drug Specific) should be available.
	4.	Every procedure should be monitored with pulse Oxymeter to observe oxygen saturation.
	5.	Major procedure undertaken should be monitored with as many varying equipments such as Airway Pressure Alarm, Oxygen, Concentration Analyser, Neuro-Muscular Monitor, Respiratory Volume Monitor, Non-invasive BP Monitor, Capnometer, etc.