AAGBI recommendations for standards of monitoring during anaesthesia and recovery 2015 (2016)

I thank Drs. Lumb and McLure for their editorial to accompany the publication of the 2015 AAGBI recommendations for standards of monitoring during anaesthesia and recovery 1, 2. It is gratifying that they feel that previous editions of these guidelines have become globally accepted as a baseline standard for monitoring to which all anaesthetists should work, and I hope the 2015 update continues this tradition. I would like to make some observations on their editorial, to clarify any misunderstandings that the authors may have about the content and philosophy of the standards. The guideline document is not designed to be a comprehensive manual of patient monitoring, but to be a useful resource to guide anaesthetists in the UK and Ireland on what the AAGBI consider to be the current minimum monitoring standards for modern clinical practice. The recommendation for un-interrupted monitoring of SpO2, NIBP, ECG and capnography from induction to recovery is difficult to argue against on safety grounds, and the Working Party recognised that this might not be immediately possible to achieve in all departments, hence the wording “departments should work towards …” in the document. This standard may be aspirational, but the Working Party believe it will indeed represent a ‘marginal gain’ in improving patient safety, which is the primary objective of the guideline. As alluded to, a degree of common sense and pragmatism is necessary when deciding what additional monitoring should be used during brief transfers to the recovery room or longer journeys to the intensive care unit, or further afield. Several manufacturers' monitoring systems now have detachable portable units that can accompany the patient during transfers, allowing seamless monitoring from induction until recovery. Other key new recommendations concern the necessity of monitoring neuromuscular function when neuromuscular drugs are used 3 and the specific situation in which depth of anaesthesia should be monitored. On the topic of oxygen therapy for patients recovering from anaesthesia, I accept that there may be a few exceptions in which it is not indicated, but it is known that there is a risk of postoperative hypoxia at this critical phase, and administering oxygen in the recovery room is now standard practice in most hospitals. The AAGBI guideline recommends that temperature should be measured at least every 30 minutes, as hypothermia develops rapidly during anaesthesia and is harmful 4. Aural canal infrared thermometers are widely available but may be inaccurate at measuring core temperature. Therefore, continuous core temperature monitoring is recommended during longer (> 60 minutes) and more complex surgical procedures. The Working Party understand that there will be resource and cost implementations for anaesthetic departments wanting to adopt these updated standards and we believe that the recommendations can help to support business cases for new and updated equipment. This is nothing new, as previous versions have raised awareness on the need to invest in appropriate equipment and adopt stricter protocols to improve patient safety.