We don’t monitor enough

The choice of which intraoperative monitors to use for routine cases is difficult, because a multitude of monitors is available today. Monitoring is deemed necessary to avoid problems, although there is little hard evidence that a specific monitor will improve outcome. The risk associated with modern noninvasive monitors, however, is negligible, and they should be considered for routine use in all patients. Although errors in the variables displayed or misuse of correct information can cause difficulties, these result from a lack of education and are not a valid reason to abandon a particular monitoring modality. Regular use of such monitoring tools as the electroencephalogram would allow clinicians to become familiar with how to interpret it in normal and crisis situations. The cost of a disaster during anesthesia (such as unrecognized hypoxia) is high. The dollars spent to cover a single major malpractice award could buy a tremendous number of monitors. The state of the art in the mid-1980s demands traditional anesthesia monitors plus continuous capnography and measurement of peripheral oxygenation. Other negligible-risk monitors should also be used when feasible. Improvement in monitoring design, particularly in output formats and in integration of monitored data, will be essential in the next few years, as will training in the proper use of monitors.