Monitoring regional anaesthesia

Monitoring patients under regional anaesthesia is more challenging than patients under general anaesthesia but it has been somewhat neglected in anaesthesia literature. The fundamental differences are that during regional anaesthesia. 1. The patient is often awake. 2. Respiration is more difficult to measure. 3. Autonomic changes influence information obtained by pulse oximetry. 4. Monitoring personnel are at a greater risk of vigilance decrement. A review of reported complications during regional anaesthesia enabled conclusions to be reached regarding monitoring policies in an institution. These include particular reference to spontaneous respiration and cerebral function. The need for an appropriately skilled person monitoring the patient in the operating room at all times is emphasized, as is the necessity for education appropriate for the skills they may have to exercise even on rare occasions. Specific instruction in vigilance decrement avoidance should be part of that curriculum.