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International anesthesia organizations' standards of monitoring during anesthesia

Organization	Continuous presence of	Descriptor	Patient monitors
ASA	Qualified anesthesia personnel	Minimum	Inspired O₂ with low O₂ limit alarm Pulse oximeter, with audible pulse tone and low threshold alarm Expired CO₂ continuous, with audible alarm, during general anesthesia or moderate/deep sedation Disconnect alarm during mechanical ventilation Continuous ECG Blood pressure and heart rate at least every five minutes During GA, pulse plethysmography or oximetry, or continuous palpation of pulse, or auscultation of heart sounds, or monitored intraarterial pressure trace, or ultrasound peripheral pulse Temperature when clinically significant changes in body temperature are anticipated or suspected
AAGBI	Anaesthetist of appropriate experience, or fully trained Physician Assistant (Anaesthesia) under the supervision of a Consultant Anesthetist	Minimum	Pulse oximeter NIBP ECG Capnography during GA and during regional anesthesia or sedation whenever there is loss of patient response to verbal contact Temperature before general anesthesia and every 30 minutes during surgery
		Should use	Inspired volatile anesthetic agent if used Inspired N₂O if used During GA: Inspired and expired oxygen, waveform capnography During mechanical ventilation, airway pressure, TV, and RR If NMBAs used, quantitative neuromuscular monitoring throughout anesthesia During TIVA with neuromuscular blockade, processed EEG
		Available	Capillary blood glucose monitoring, blood gas analysis, hemoglobin measurement, flexible bronchoscopy
		Additional	Invasive blood pressure, cardiac output at discretion of anaesthetist
EBA	Appropriately trained and experienced anaesthesiologist	Essential	Pulse oximeter NIBP ECG Airway gases: O₂ with audible alarm, CO₂, vapour when volatile anesthetics used Airway pressure
EBA	Appropriately trained and experienced anaesthesiologist	Available	Peripheral nerve stimulator with NMBAs Temperature
WHO-WFSA	Vigilant anesthesia professional	Highly recommended (mandatory)	Audible signals and alarms Pulse oximeter, including heart rate CO₂ detector for intubated patients NIBP
		Recommended	Continuous monitoring with stethoscope (precordial, pretracheal, or oesophageal) Continuous capnography during GA or deep sedation Continuous ECG Peripheral nerve stimulator with muscle relaxants Oxygen concentration monitoring, including inspired concentration and device to prevent delivery of hypoxic gas mixture Disconnect alarm during mechanical ventilation Intermittent temperature monitoring
		Suggested	Inspiratory and/or expired gas volumes, and concentration of volatile agents Invasive blood pressure in appropriate cases Continuous electronic temperature monitoring in appropriate cases Processed EEG in appropriate cases Urine output in appropriate cases
CAS	Physician or an anesthesia assistant (with appropriate training and experience) under the immediate supervision of an anesthesiologist	Required	Pulse oximeter BP (either invasive or non-invasive) ECG Capnography for GA and sedation Agent-specific anesthetic gas analyser with inhalation agents
		Exclusively available for each patient	Temperature Peripheral nerve stimulator when NMBAs used Stethoscope (precordial, esophageal, or paratracheal) Lighting appropriate to visualize an exposed portion of the patient
		Immediately available	Spirometer Manometer to measure ETT cuff pressure Equipment for invasive hemodynamic monitoring (ie, intra-arterial, CVP)
		Available	Depth of anesthesia monitoring equipment to be considered for use in patients at increased risk for intraoperative awareness
ANZCA	Vigilant anaesthetist, practitioner, medical practitioner	Mandatory	Pulse oximeter CO₂ monitor during GA ECG NIBP Inspired and end tidal concentration of inhaled anesthetics when used Temperature when warming devices used Neuromuscular function monitor (quantitative preferred) when considering extubation after use of nondepolarizing NMBAs
ANZCA	Vigilant anaesthetist, practitioner, medical practitioner	Available	CO₂ monitor during sedation Continuous invasive blood pressure Temperature Neuromuscular function monitor when NMBAs used Temperature Other (EEG, CVP, CO, TEE, respiratory mechanics) when clinically indicated

ASA: American Society of Anesthesiologists Standards for Basic Anesthetic Monitoring. Committee of Origin: Standards and Practice Parameters (Approved by the ASA House of Delegates on October 21, 1986, last amended on October 20, 2010, and last affirmed on October 28, 2016). Available at https://www.asahq.org/~/media/Sites/ASAHQ/Files/Public/Resources/standards-guidelines/standards-for-basic-anesthetic-monitoring.pdf.
AAGBI: Association of Anaesthetists of Great Britain and Ireland. Available at https://anaesthetists.org/Home/Resources-publications/Guidelines/Recommendations-for-standards-of-monitoring-during-anaesthesia-and-recovery-2021.
EBA: European Board of Anaesthesiology. Available at http://www.eba-uems.eu/resources/PDFS/safety-guidelines/EBA-Minimal-monitor.pdf.
WHO-WFSA: World Heath Organization - World Federation of Societies of Anaesthesiologists. Gelb AW, Morriss WW, Johnson W, et al. World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia. Can J Anaesth 2018.
CAS: Canadian Anesthesiologists' Society. Available at https://www.cas.ca/CASAssets/Documents/Practice-Resources/Guidelines/Dobson2021_Article_GuidelinesToThePracticeOfAnest_1.pdf.
ANZCA: Australian and New Zealand College of Anaesthetists. Available at https://www.anzca.edu.au/getattachment/0c2d9717-fa82-4507-a3d6-3533d8fa844d/PS18-Guideline-on-monitoring-during-anaesthesia.

O₂: oxygen; CO₂: carbon dioxide; ECG: electrocardiogram; GA: general anesthesia; NIBP: non-invasive blood pressure; N₂O: nitrous oxide; NMBAs: neuromuscular blocking agents; EEG: electroencephalogram; TIVA: total intravenous anesthesia; HR: heart rate; ETT: endotracheal tube; CVP: central venous pressure; CO: cardiac output; TEE: transesophageal echocardiography.

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