Monitoring

Anaesthesia for high risk surgical patients needs to be planned carefully with due consideration to all of the features that will or have the potential to provide problems intra and post operatively. Some of these are predictable and some are not. In either case information that identifies problems as they occur or preferably before they have a chance to be troublesome has to be advantageous. There are an ever increasing array of monitoring devices that provide information. While it is true to say that all information has some intrinsic value the relative value of that information when compared to the cost of its acquisition is pertinent. Many monitors provide surrogate information that represents, often poorly, the values that would be useful. Other devices are time consuming and preoccupy the anaesthetist without necessarily contributing to the management of the anaesthetic. It is foolhardy and potentially hazardous to adopt prescriptive monitoring for different types of anaesthetic. Discerning and discriminatory selection of appropriate monitoring is vital for the safe conduct of high risk surgical patients.