Monitors and Equipment for the Ambulatory Surgical Care Setting

  • Tjorvi E. PerryEmail author
  • Kumar G. Belani


As Ambulatory Surgical Centers (ASC) become increasingly popular in the United States, proper anesthesia equipment and monitoring are foundational for ensuring the delivery of safe and efficient anesthetic care. Herein, we will review standard and expected monitoring every ASC should consider in order to meet their stated mission, including pulse oximetry, non-invasive blood pressure, electrocardiographic, temperature and capnographic monitoring. We will also discuss the use of the bispectral index, near infra-red spectroscopy and monitoring after the administration of neuromuscular blockade. These guidelines apply to all forms of anesthesia administered by an anesthesiologist or anesthesia care team including general anesthesia, regional anesthesia and deep sedation, in both adults and children.


Ambulatory surgical center Ambulatory anesthesia Standard monitoring Standard equipment Patient safety 


  1. 1.
  2. 2.
  3. 3.
    Committee on Ambulatory Surgical Care. Guidelines for Office-Based Anesthesia; 2014.Google Scholar
  4. 4.
    Committee on Ambulatory Surgical Care. Standards for Basic Anesthetic Monitoring; 2014.Google Scholar
  5. 5.
    Sub-Committee of ASA Committee on Equipment and Facilities. Recommendations for Pre-Anesthesia Checkout Procedures; 2008.Google Scholar
  6. 6.
    World Health Organization, Anesthesia Safety Checklist SS& SA. Gas and Vacuum Supplies.Google Scholar
  7. 7.
    POISE Study Group. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371(9627):1839–47.CrossRefGoogle Scholar
  8. 8.
    INPRESS Study Group. Effect of individualized vs standard blood pressure management strategies on postoperative organ dysfunction among high-risk patients undergoing major surgery: a randomized clinical trial. JAMA. 2017;318(14):1346–57.CrossRefGoogle Scholar
  9. 9.
    Maheshwari K, Khanna S, Bajracharya GR, Makarova N, Riter Q, Raza S, Cywinski JB, Argalious M, Kurz A, Sessler DI. A randomized trial of continuous noninvasive blood pressure monitoring during noncardiac surgery. Anesth Analg. 2018;127(2):424–31.CrossRefGoogle Scholar
  10. 10.
    Larach MG, Brandom BW, Allen GC, Gronert GA, Lehman EB. Malignant hyperthermia deaths related to inadequate temperature monitoring, 2007-2012: a report from the North American malignant hyperthermia registry of the malignant hyperthermia association of the United States. Anesth Analg. 2014;119(6):1359–66.CrossRefGoogle Scholar
  11. 11.
    Liu S. Effects of Bispectral Index monitoring on ambulatory anesthesia: a meta-analysis of randomized controlled trials and a cost analysis. Anesthesiology. 2004;101(2):311–5.CrossRefGoogle Scholar
  12. 12.
    Barash P, Bieterman KHD. Game changers: the 20 most important anesthesia articles ever published. Anesth Analg. 2015;120(3):663–70.CrossRefGoogle Scholar
  13. 13.
    Brull SJ, Kopman AF. Current status of neuromuscular reversal and monitoring: challenges and opportunities. Anesthesiology. 2017;126:173–90.CrossRefGoogle Scholar
  14. 14.
    Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg. 2010;111(1):110–9.CrossRefGoogle Scholar
  15. 15.
    The APSF Collaborative Panel on Neuromuscular Blockade and Patient Safety. Neuromuscular Blockade and Patient Safety; 2017.
  16. 16.
    American Society of Anesthesiologists Task Force on Postanesthetic Care. Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology. 2013;118(2):291–307.CrossRefGoogle Scholar
  17. 17.
    Checketts MR, Alladi R, Ferguson K, Gemmell L, Handy JM, Klein AA, Love NJ, Misra U, Morris C, Nathanson MH, Consultant G, Rodney E, Verma R, Pandit JJ. Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2016;71(1):85–93.CrossRefGoogle Scholar
  18. 18.
    Thilen SR, Bhananker SM. Qualitative neuromuscular monitoring: how to optimize the use of a peripheral nerve stimulator to reduce the risk of residual neuromuscular blockade. Curr Anesthesiol Rep. 2016;6:164–9.CrossRefGoogle Scholar
  19. 19.
    Della Rocca G, Pompei L, Pagan DE Paganis C, Tesoro S, Mendola C, Boninsegni P, Tempia A, Manstretta S, Zamidei L, Gratarola A, Murabito P, Fuggiano L, DI Marco P. Reversal of rocuronium induced neuromuscular block with sugammadex or neostigmine: a large observational study. Acta Anaesthesiol Scand. 2013;57(9):1138–45.CrossRefGoogle Scholar
  20. 20.
    Brueckmann B, Sasaki N, Grobara P, Li MK, Woo T, de Bie J, Maktabi M, Lee J, Kwo J, Pino R, Sabouri AS, McGovern F, Staehr-Rye AK, Eikermann M. Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study. Br J Anaesth. 2015;115(5):743–51.CrossRefGoogle Scholar
  21. 21.
    Nielsen H. Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery. Front Physiol. 2014;5(93):1–15.Google Scholar
  22. 22.
    Picton P, Dering A, Alexander A, Neff M, Miller BS, Shanks A, Housey M, Mashour GA. Influence of ventilation strategies and anesthetic techniques on regional cerebral oximetry in the beach chair position: a prospective interventional study with a randomized comparison of two anesthetics. Anesthesiology. 2015;123(4):765–74.CrossRefGoogle Scholar
  23. 23.
    Jeong H, Jeong S, Lim HJ, Lee J, Yoo KY. Cerebral oxygen saturation measured by near-infrared spectroscopy and jugular venous bulb oxygen saturation during arthroscopic shoulder surgery in beach chair position under sevoflurane-nitrous oxide or propofol-remifentanil anesthesia. Anesthesiology. 2012;116(5):1047–56.CrossRefGoogle Scholar
  24. 24.
    Kent CD, Stephens LS, Posner KL, Domino KB. What adverse events and injuries are cited in anesthesia malpractice claims for nonspine orthopaedic surgery? Clin Orthop Relat Res. 2017;475(12):2941–51.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of Minnesota Medical CenterMinneapolisUSA
  2. 2.Department of AnesthesiologyUniversity of Minnesota Masonic Children’s HospitalMinneapolisUSA

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