Monitoring requirements will depend on the nature and extent of the planned surgery and the patient's condition. In all cases, there should be continuous monitoring of the electrocardiogram (ECG), blood pressure, pulse oximetry, inspired oxygen, expired CO2 and anesthetic gas concentrations. Invasive blood pressure monitoring via an intra-arterial line is required for major intracranial and spinal surgery, but non-invasive blood pressure monitoring may be adequate for less extensive operations such as shunts, burr-hole biopsies and more minor spinal surgery where there is no risk of cord ischemia. The central venous pressure (CVP) should be monitored for vascular cases and where major blood loss is anticipated. More extensive cardiovascular monitoring, such as of pulmonary artery pressures, may be indicated by the patient's condition (e.g. severe ischemic heart disease), but is not routinely necessary. The core temperature should be monitored except in the shortest cases and can be recorded at several sites including the esophagus, where the temperature probe can be combined with an esophageal stethoscope. A peripheral nerve stimulator is mandatory in order to monitor the effects of the neuro-muscular blocking drugs, as patient movement or coughing could be disastrous during neuro-surgical operations.
For patients in the sitting position, precordial Doppler ultrasonography, transesophageal echocardiography and pulmonary artery pressure monitoring may be used to detect venous air embolism.
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