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Monitoring in private anaesthetic practice.

Cardiac arrest group All patients who suffered a cardiac arrest had ECG monitoring at the time. A slight trend towards the increased use of both lAP and CVP monitoring was evident in this group, suggesting that potential haemodynamic instability may have been increasingly recognised in this group over the study period. There appear to have been only two other recent major studies of intraoperative cardiac arrests,6.7 neither of which analysed the monitors in use before the arrest. Documentation ofthe details of the role played by monitors prior to and after a cardiac arrest would seem to be a worthwhile way of assessing the relative value of different monitoring devices in the diagnosis and management of cardiac arrests. The main point to emerge from the discussion was the great variation in both surgical and anaesthetic practice across Australia. For example, between 1984 and 1986 some hospitals had no oxygen analysers but always used disconnect alarms, some had oxygen analysers but no disconnect alarms, some had both, and some had neither. This variability reflects the difficulties facing anaesthetists in deciding what monitors are needed. It was recognised that the study would have been enhanced if all clinical as well as equipment-based monitoring had been documented in detail. Also, it was recognised that it would have been useful if the frequency with which the use of different monitors had led to the detection of problems had been documented. These and other points are being addressed in a multi-centre anaesthesia incident reporting study, plans for which are discussed in the last article in this issue.