Peer reviewed

Anesthetic
Monitoring
Devices to Use &
What the Results Mean
Jeff Ko, DVM, MS, Diplomate ACVA, and
Rebecca Krimins, DVM

This article is the second in a

T
he main fundamental aspects of anesthetic monitor-
ing are:
series discussing the goals of 1. Oxygenation (circulatory and respiratory func-
tion)
anesthetic monitoring as well 2. Ventilation (respiratory function)
as associated procedures 3. Circulation (circulatory function with an empha-
sis on cardiac output).
and equipment. In the first These three elements work simultaneously in order to maintain
adequate tissue and organ perfusion with oxygenated blood.1-3
article, the authors answered Oxygenation and ventilation are essential for maintaining a
high oxygen level in the blood, while cardiac output plays a
questions about anesthetic pivotal role in maintaining tissue and organ perfusion with highly
monitoring, including why oxygenated blood. In this way, oxygenation, ventilation, and cir-
culation each play a critical role in providing oxygen to tissues.
itÕs performed, information
PHYSIOLOGY FUNDAMENTALS
obtained during monitoring, Oxygen Delivery
Oxygen delivery is a product of blood oxygenation and cardiac
and important components output.1-3
of the anesthetic process. • Blood oxygenation is represented by blood oxygen con-
tent, which is the total amount of oxygen carried by the
blood, including oxygen dissolved in plasma and oxygen
bound to hemoglobin.1-3
• Cardiac output is maintained by a complex interaction
involving heart rate, stroke volume, peripheral vascular
resistance (afterload), blood volume returning to the heart
(preload), and blood viscosity.1-3

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When heart rate or stroke volume or a combination

of both is low, cardiac output is reduced. When blood
Table 1. Anesthetic Monitoring equipment
volume returning to the heart is low due to dehydra-
Circulation tion or acute blood loss, stroke volume is decreased.
Electrocardiography (ECG): If peripheral vascular resistance or blood viscosity
• Monitors heart rate and rhythm (ie, vasoconstriction or polycythemia, respectively)
• Definitively diagnoses arrhythmias is increased, cardiac output is reduced. In addition,
• Monitors progress of cardiac arrhythmia treatment excessively high heart rate (lack of ventricular filling
for preload) and profound peripheral vascular dilation
Ultrasonic Doppler blood flow detector:
• Measures blood flow, pulse rate, and systolic blood (lack of venous return due to peripheral pooling of
pressure (BP) when used with sphygmomanometer blood) also reduce cardiac output.
Oscillometric BP measurement: Application to Anesthesia
• Uses a BP cuff on the limb to obtain systolic, Acute changes in ventilation or oxygenation can
diastolic, and mean arterial BP at a set time interval
have dramatic effects on oxygen delivery; thus, in
but not continuously
addition to monitoring circulatory function (see
Invasive BP measurement: CIRCULATION, below), it is important to carefully
• Uses arterial catheter, BP transducer, and monitor monitor:
to obtain continuous beat-to-beat pulse waves • Saturation level of oxygen in hemoglobin via SaO2
• gold standard for measuring systolic, diastolic, and (measured by blood gas analysis) or SpO2 (mea-
mean BP sured by pulse oximetry)
Ventilation • Hematocrit (an important indicator of hemo-
Respirometer: globin concentration; hemoglobin concentration
• Measures respiratory rate and tidal volume (minute equals approximately 1/3 of the hematocrit)
volume) • Partial pressure of oxygen in arterial blood
Arterial or venous blood gas: (PaO2).
• Measures partial pressure of co2 (Paco2 or When oxygen delivery is inadequate, cells seek
Pvco2) alternative ways to supply energy (ATP). The body
then converts to anaerobic metabolism, producing
Capnography:
lactate as a metabolic by-product and utilizing it as an
• noninvasively measures end-tidal co2
alternative energy source.4 Measuring a series of blood
concentration
lactate concentrations provides a trend for assessing
Oxygenation tissue perfusion.1-4
Pulse oximetry: Following is a categorization of anesthetic monitor-
• noninvasively measures saturation of oxygen ing equipment by physiologic function. See Table 1
bound to hemoglobin (spo2) and Figure 1 for an outline of anesthetic monitoring
Arterial blood gas: equipment and its purposes.
• Measures partial pressure of oxygen (Pao2) in
arterial blood samples CIRCULATION
Body Temperature Monitoring circulation during general anesthesia is
aided by the use of electrocardiography (ECG) and
Rectal thermometer
Esophageal temperature probe
blood pressure (BP) monitoring as well as patient
Infrared thermometer: assessment.
• Measures tympanic membrane temperature
Electrocardiography
Depth of Anesthesia
Electrocardiography is easy to perform and should be
Anesthetic gas analyzer: used continuously during the perioperative period to
• Measures expiratory inhalant concentration obtain quick, real-time information about heart rate
(allows anesthetist to estimate depth of anesthesia and rhythm.
together with other vital variables mentioned in this
table)
Placement
Bispectral index (BIS) monitor:
The majority of ECGs used in veterinary hospitals
• Algorithmic analysis of a patient’s
electroencephalogram during general anesthesia
have 3 leads and attach to the skin surface.
• The 3 leads can be placed as either:
BIS = bispectral index; BP = blood pressure; CO2 = carbon dioxide;
ECG = electrocardiography; PaCO2 = partial pressure of carbon dioxide
» Limb leads: Left and right forelimb and left
in arterial blood; PaO2 = partial pressure of oxygen in arterial blood; hindlimb electrodes attached to the limbs as indi-
PvCO2 = partial pressure of carbon dioxide in venous blood; SpO2 = cated, with selection of lead II during recording
saturation level of oxygen in hemoglobin as measured by pulse oximetry » Base-apex leads: Right forelimb and left

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Table 2. cardiorespiratory & Physiologic Parameters in the Anesthetized Dog & cat
Variable reference interval (Dogs) reference interval (cats)
Circulation heart rate (beats per min) 60–120 120–160
systolic blood pressure (mm hg) 90–140 90–140
Diastolic blood pressure (mm hg) 60–90 60–90
Mean arterial blood pressure (mm hg) 70–90 70–90
Ventilation respiratory rate (breaths per min) 8–16 12–24
Tidal volume (ml/breath) 10–15 10–15
Arterial blood ph 7.35–7.45 7.35–7.45
Paco2 (mm hg) 35–45 35–45
Bicarbonate (mmol/l) 22–26 22–26
end-tidal co2 (mm hg) 35–45 35–45
Oxygenation spo2 (%) ≥ 95 ≥ 95
Pao2 (mm hg) ≥ 100 ≥ 100
Other Body temperature (°F) 98–101 98–101
hematocrit (%) 34–59 28–47
Total protein (mg/dl) 5–8.3 5.9–8.4
Blood glucose (mg/dl) 90–150 90–150
Blood lactate (mmol/l) <2 <2
Urine output (ml/kg/h) 1–2 1–2
CO2 = carbon dioxide; PaCO2 = partial pressure of carbon dioxide in the arterial blood; PaO2 = partial pressure
of oxygen in the arterial blood; SpO2 = saturation level of oxygen in hemoglobin as measured by pulse oximetry

Lisa wirth, vMd

Figure 1. A schematic representation of clinical anesthesia monitoring equipment to ensure proper tissue perfusion
with well-oxygenated blood. Continous systemic surveillance can provide an early warning system, prompting
immediate intervention.

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hindlimb electrodes attached to the right (pre- Placement

ferred) or left (alternative) jugular furrow, and Arterial catheter placement is usually in the dorsal pedal/
left forelimb electrode attached to the opposite metatarsal, femoral, or palmar artery. In dogs with
side of the thoracic wall caudal to the heart large ears, such as basset hounds, the catheter may be
(Figure 2). Select either lead I (negative deflec- placed in the auricular artery. In cats, arterial catheters
tion) or lead III (positive deflection) on the are most frequently placed in the dorsal pedal artery.
monitor for recording.
• The advantage of using base-apex lead placement Advantages & Disadvantages
is that it avoids attachment to the hindquarters, Advantages:
minimizing artifact motion during abdominal and • Accurate pressure readings with beat-to-beat infor-
hindlimb surgical manipulation. mation
• The application of conduction gel and/or medical • Arterial blood sampling for blood gas analysis,
alcohol on the ECG electrodes minimizes artifact packed cell volume (PCV), glucose, and lactate
and background electrical noise on the monitor. measurement.

Disadvantages:
• Technical skill required to place the catheter
• Expense of equipment required
• Frequent maintenance (of pressure transducer,
pressure tubing, saline flushing) and calibration
• Potential hematoma formation and thrombosis
(rare)
• Infection at the catheter insertion site and acute
blood loss if an inadvertent disconnection occurs
between the catheter and artery (rare).

Noninvasive Blood Pressure Measurement

BP monitoring is more commonly accomplished
Figure 2. A base-apex lead is placed on a dog with through noninvasive (indirect) BP monitoring using a
right forelimb (RA) and left hindlimb (LL) electrodes Doppler ultrasound or oscillometric method.
positioned on the right jugular furrow of the dog,
and the left forelimb (LA) electrode placed caudal to Ultrasonic Doppler Method
the heart to obtain the best signal. The ECG monitor The ultrasonic Doppler method involves placing a
settings are selected for lead I or lead III. probe on top of an artery with conduction gel applied
between the skin and the probe (Figure 4). The probe
uses ultrasonic waves to detect pulsatile blood flow
Limitations or vessel wall motion and converts this to an audible
ECG indicates electrical activity but does not offer signal.
information about the mechanical function of the
heart (ie, pumping activity). A form of cardiac arrest Placement
called electromechanical dissociation can occur where Any superficial artery can be used (usually limb extrem-
there is electrical activity of the heart but no pulse ities or ventral tail base) for detection of blood flow. A
present. Therefore, ECG should not be used as a sole blood pressure cuff is placed proximal to the ultrasonic
monitoring tool for circulatory function periopera- probe and is inflated to the point where it exceeds
tively. systolic blood pressure, which silences the Doppler
signal. The cuff is then gradually deflated until the first
Invasive Blood Pressure Measurement noise signal is audible. The blood pressure registered
The gold standard for BP measurement is an arterial on the sphygmomanometer at this time is the systolic
catheter connected to a monitor via a pressure trans- blood pressure.
ducer (Figure 3). Invasive (direct) BP monitoring
provides beat-to-beat information about BP and heart Advantages
(pulse) rate and rhythm. Arrhythmias can be identified • Continuous flow noise is produced.
by changes in arterial wave form on the monitor, which • Systolic BP measurement is relatively accurate
may also be accompanied by acute reductions in BP compared with direct BP monitoring.
values. Information on arrhythmias diagnosed by ECG, • Equipment cost is low.
coupled with changes in BP values, allows the anesthe-
tist to determine the severity of the arrhythmias and Disadvantages
whether to initiate crucial therapeutic actions. • This method only measures systolic blood pressure.

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Depending on the algorithm

used, some devices directly mea-
sure systolic and diastolic blood
pressure and calculate to yield
mean arterial blood pressure,
while others measure mean arte-
rial blood pressure directly and
then calculate systolic and dia-
stolic blood pressures.

Placement
The BP cuff is inexpensive and
placed on a limb extremity or the
base of the tail and leveled with
the heart during measurement.
The width of the blood pressure
cuff should be 40% of the limb
circumference.

Figure 3. An arterial catheter Figure 4. An ultrasonic Doppler Advantages

placed in the dorsal pedal artery is in use: Notice the BP cuff • This method is inexpensive
of a dog and connected to a is positioned proximal to the and easy to use.
transducer to record direct BP; Doppler probe and connected to a • The machine can be set to
placement of a stopcock permits sphygmomanometer for measuring take automatic measurements
periodic sampling of arterial systolic BP (in this case a reading at specified time intervals.
blood for blood gas analysis of 130 mm Hg). The Doppler probe
and measurements of PCV, total is taped firmly to the palmar/plantar
Disadvantages
protein, blood glucose, and lactate. aspect of the distal metacarpals/
metatarsals.
• Technology is motion sensitive
and has difficulty reading BP
if patient movement, hypoten-
sion, bradycardia, or arrhyth-
mias are present.
• Method is less accurate compared to ultrasonic
Doppler and invasive BP monitoring.
• Variable size and shape of limbs can contribute to
inaccuracies, especially in smaller patients (cats
and small dogs).
Recent advances in technology are producing
improved software and hardware capable of overcom-
ing many of these disadvantages.

VENTILATION
Various aspects of respiratory function can be mea-
Figure 5. An oscillometric monitor with BP cuff
sured using a respirometer, capnometry, and/or blood
used on a front limb of a dog: Notice the oscillo-
gas analysis.
metric BP provides systolic (96 mm Hg), diastolic
(63 mm Hg) and mean arterial blood pressures (74
mm Hg) with heart rate (109 beats/min). Respirometer
Respirometry assesses tidal volume and minute vol-
ume in the anesthetized patient. Minute volume (mL/
• BP has to be measured each time by the anes- min) is the product of tidal volume (mL) and respira-
thetist because the equipment cannot be set for tory rate of the patient:
automatic measurements.
• When vasoconstriction or hypotension occurs, the minute volume = tidal volume × respiratory rate
signal can be relatively weak and difficult to obtain.
A respirometer measures expiratory volume and can
Oscillometric Method be placed between the expiratory limb of an anes-
Oscillometric BP monitoring (Figure 5) is used to thetic machine and the anesthetic breathing hose.
measure systolic, diastolic, and mean arterial BP. Alternatively, it can be connected to a tightly-fitting face

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Results from several human and animal studies show

that venous blood sample pH is an acceptable sub-
stitute for arterial measurement, and venous CO2
(PvCO2) may be used to detect hypercarbia. However,
there may not be sufficient agreement between arterial
and venous PCO2 to allow use of venous blood samples
for clinical evaluation of ventilatory function.
Handheld blood gas analyzers, such as the iStat
system (abaxis.com), VetStat system (idexx.com), and
VitalPath analyzer (heska.com), make blood gas analy-
sis more practical and available for veterinary practices.

Capnometry
Figure 6. A respirometer attached to the face
End-tidal carbon dioxide (ETCO2) monitoring allows
mask of a dog to measure tidal volume and
exhaled CO2 to be measured noninvasively and
respiratory rate
reflects PaCO2. Monitoring ETCO2 is useful for:
• Determining optimal ventilation efficiency
mask and used to assess ventilation in a nonintubated, • Diagnosing respiratory, airway, or device prob-
sedated patient (Figure 6). lems, such as apnea, hypoventilation, airway dis-
The true usefulness of respirometry is to pinpoint connection, airway obstruction, leak in the endo-
whether respiratory rate and/or tidal volume are inad- tracheal tube cuff, exhaustion of CO2 absorbent,
equate (based on the equation of minute volume) when and incompetent one-way valve of anesthetic
end-tidal CO2 or PaCO2 is elevated. rebreathing circuit
• Reflection of adequate cardiac output production
Blood Gas Analysis (eg, sudden, acute drops in cardiac output are
Arterial blood gas analysis and resultant partial pres- associated with decreases in ETCO2 measure-
sure of CO2 in arterial blood (PaCO2) can be used ments due to poor pulmonary circulation).
to assess ventilation in the anesthetized patient. Capnometry is the measurement and numerical
The arterial blood sample is collected directly from display of ETCO2 during the respiratory cycle (inspi-
an artery or through a preplaced arterial catheter ration and expiration). A capnometer measures and
(Figure 3). displays the readings without a graphic presentation;
Although more accurate than a respirometer, PaCO2 capnography refers to the comprehensive measure-
measurement requires a blood gas analyzer and arte- ment of CO2 using a graphic recorder that displays CO2
rial blood samples. If arterial blood samples are not concentration in real-time, throughout the respiratory
available, venous blood samples may be used instead. cycle (Figures 7 and 8).

Figure 7. Side-stream capnography: Notice the Figure 8. A main-stream anesthetic agent analyzer, with
adaptor (white color) is connected between a an adaptor connected between a breathing circuit and
breathing circuit and the endotracheal tube to the endotracheal tube, analyzes isoflurane concentration
sample the inspired and expired gas (via the (inspired concentration of 1.6% and expired concentration
transparent tubing); the sample is analyzed in of 1.3% ) and end-tidal CO2 (ETCO2 of 36 mm Hg, respira-
the monitor. Also visible is an esophageal stetho- tory rate of 17 breaths/min) of the anesthetized dog. Notice
scope (black tubing) inserted into the esophagus the main-stream adaptor is bulkier than the side-stream
of the dog for auscultation of heart and lung adaptor (Figure 7) and the exhaled gas is analyzed (blue
sounds, and a pulse oximeter probe (white tubing) light) within the adaptor using infrared technology.
on the patient’s tongue.

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This technique:
• Is relatively inexpensive.
• Allows for continuous monitoring of ventilation.
• Limits the need for invasive procedures, such as
arterial blood gas sampling.
• Provides valuable information on the respira-
tory status of the patient, including whether the
patient has had an inadvertent esophageal intu-
bation.
• Identifies if the patient is rebreathing carbon
dioxide (eg, too much dead space within breath-
ing circuit, inadequate oxygen flow rate used for
non-rebreathing circuit, CO2 absorbent exhaust-
ed, or a mechanical problem with one-way valve Figure 9. Pulse oximetry with a lingual probe
of anesthetic rebreathing circuit). placed on the tongue of a dog. Notice the place-
ment of wet gauze between the probe and the
What the Numbers Mean tongue to minimize air pockets and improve the
ETCO2 measurements usually underestimate actual contact between the tongue and the probe.
PaCO2 measurements by 5 to 10 mm Hg. The discrep-
ancy between ETCO2 and PaCO2 measurements is
due to alveolar dead space. In the conscious patient,
usually attached to the patient’s tongue, lip, ear,
ETCO2 and PaCO2 measurements are very similar.
or interdigital space)
However, the anesthetized patient has increased
• Provides the pulse rate of the patient.
alveolar dead space, which results in lower ETCO2
Pulse oximeter function may be affected by many
measurements.
factors, including:
• Normal PaCO2 measurements in the anesthetized
• Motion artifact (eg, shivering or body movement)
dog and cat are equal to 35 to 45 mm Hg.
• Ambient light (eg, fluorescent light affecting
• ETCO2 (and PaCO2) values higher than 45 mm
proper reading of pulse oximeter)
Hg are consistent with hypoventilation. They
• Poor peripheral blood flow due to hypotension or
alert the anesthetist that the patient may need to
vasoconstriction
breathe more frequently and/or with a larger tidal
• Electrical noise from surgical instruments (eg,
volume. Hypoventilation is usually associated
electrocautery)
with anesthetic-induced respiratory depression.
• Increased blood carboxyhemoglobin and methe-
• ETCO2 (and PaCO2) values lower than 35
moglobin levels
mm Hg may be evidence of hyperventilation.
• Dark pigmentation of the skin or tongue.
Hyperventilation is often associated with pain,
light plane of anesthesia, and/or increased body
Relationship Between SpO2 and PaO2
temperature.
• Normal pulse oximeter readings (SpO2) in anes-
For a complete list of normal cardiorespiratory and
thetized dogs and cats breathing 100% oxygen
physiologic parameters in the anesthetized patient, see
should be 98% to 100%.
Table 2, page 25.
• Normal PaO2 in the anesthetized dog and cat
breathing 100% oxygen should be greater than
OXYGENATION
200 mm Hg and can be as high as 650 mm Hg.
A patient’s oxygenation status can be measured by
• A SpO2 of 90% corresponds to a PaO2 of 60 mm
blood gas analysis for PaO2 (see Blood Gas Analysis
Hg, which indicates hypoxemia. Hypoxemia is
under VENTILATION), hemoximetry, and pulse
insufficient oxygenation of arterial blood and is
oximetry. Hemoximetry and pulse oximetry both
considered to be present if:
analyze hemoglobin saturation in oxygen, with
» PaO2 is less than or equal to 60 mm Hg
hemoximetry providing a more precise measure-
» SpO2 is less than or equal to 90%.
ment. However, it is unusual to use hemoximetry in
In the clinical setting, PaO2 can be estimated using
veterinary practice.
pulse oximetry:
PaO2 = SpO2 – 30
Pulse Oximetry
(for pulse oximeter readings between 75% and 90%)
Pulse oximetry (Figure 9):
This formula only applies to a certain range of pulse
• Calculates the percentage of oxyhemoglobin and
oximeter readings because of the linear relationship
reduced hemoglobin present in arterial blood
between the PaO2 and SpO2 values on the mid portion
• Provides noninvasive, continuous detection of
of the hemoglobin disassociation curve. Outside of
pulsatile arterial blood in the tissue bed (probe is
these values, this rule cannot be applied.

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DEPTH OF LABORATORY ANALYSIS

ANESTHESIA Hematocrit & Total Protein
An anesthetic gas analyz- Hematocrit (PCV) not only reflects the blood’s oxygen
er (Figure 8) measures carrying capacity, in certain surgical cases, monitor-
end-tidal inhalant con- ing perioperative serial PCVs coupled with serial total
centration (halothane, protein levels can also aid the anesthetist in proper
isoflurane, sevoflurane, fluid management, including crystalloid, colloid, and
or desflurane). While blood transfusion therapy. Anemic patients (perioper-
this value is not a direct ative PCV < 20%) have low oxygen content (decreased
representation of the oxygen carrying capacity due to low hemoglobin
depth of anesthesia, it concentrations) and, therefore, lower oxygen will be
provides a more precise delivered to tissues despite normal cardiac output.
method for determining
the patient’s uptake of Blood Glucose
anesthetic, in compari- Blood glucose monitoring provides vital information
son to the vaporizer dial about a patient’s glycemic stage. This is particularly
setting. important in the pediatric, diabetic, or septic patient.
Figure 10. Blood lactate can
Minimum alveolar con- Blood glucose levels that are too high or too low can
be easily measured with a
centration (MAC) is the contribute to prolonged recovery from anesthesia.
commercial lactate meter. In
this case, the lactate meter inhalant anesthetic con- Monitoring blood glucose levels throughout the peri-
has been previously validated centration in the lungs operative period helps the anesthetist make appro-
for use in dogs. required to prevent pur- priate decisions regarding dextrose supplementation
poseful movement in and/or insulin dosing.
50% of animals (dogs or
cats) in response to surgical (skin incision) stimulus. Blood Lactate
Understanding MAC in combination with end-tidal Normal lactate concentration is less than 2 mmol/L.4
anesthetic gas concentration can help the anesthetist As previously mentioned, blood lactate concentration
avoid too light or deep anesthesia in a patient. will increase if tissue perfusion is inadequate, or if
A surgical plane of inhalant anesthesia is usually 1.3 oxygen supply is insufficient to meet the tissue oxygen
to 1.5 times MAC. Dogs or cats that are maintained
on greater than 1.5 to 2 times MAC (one MAC of iso-
flurane = 1.28% for dogs and 1.63% for cats) of any Jeff Ko, DVM, MS,
given inhalant are likely to be in a very deep plane of Diplomate ACVA,
anesthesia (especially in the premedicated patient). is a professor in
Evaluating MAC can prompt the anesthetist to assess the Department of
the patient and ensure that the cardiorespiratory func- Veterinary Clinical
tions are appropriate and not severely depressed by Sciences at Purdue
the inhalant. University College of
Veterinary Medicine.
BODY TEMPERATURE He has authored
Monitoring body temperature in order to prevent numerous articles and
hypothermia and hyperthermia is vital. Body temper- book chapters in the field of anesthesia and
ature should be monitored perioperatively every 5 to pain management. Dr. Ko lectures extensively
10 minutes until the patient has recovered to sternal at regional, national, and international
recumbency and body temperature is maintained conferences. Dr. Ko can be reached at jcko@
purdue.edu.
between 99°F to 102°F.
Rebecca Krimins,
Hypothermia may result in inability to metabolize
DVM, is currently a third-
anesthetic drugs, prolonged recovery, and impairment
year anesthesia resi-
of wound healing. Hyperthermia may result in neuro-
dent in the Department
logic damage or death if not treated aggressively and in of Veterinary Clinical
a timely manner; it also results in the patient becoming Sciences at Purdue
hypermetabolic, which increases the need for oxygen University College of
and glucose. Veterinary Medicine. Dr.
Body temperature can be monitored continuously Krimins received her DVM
with an esophageal temperature probe that measures from Ross University
the temperature of blood flowing through the aorta. School of Veterinary Medicine and her under-
Alternatively, a rectal or tympanic temperature can be graduate degree from University of Chicago.
obtained with a regular thermometer.

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demand. An elevated lactate level in a patient during the

perioperative period requires immediate evaluation of
both cardiac output and oxygenation; it also aids the
anesthetist in determining appropriate corrective actions.
Lactate is produced when oxygen delivery cannot meet
tissue oxygen demands, and the compensatory increase in
oxygen extraction is not sufficient to sustain aerobic metab-
olism. Cells will use anaerobic metabolism as an alternative
energy source, producing the by-product lactate.4
Blood lactate concentration can be easily measured
with a single drop of blood (Figure 10) using a validated
lactate meter for dogs (Lactate Pro hand-held analyser,
kdk.com).5

Urine Output
Under general anesthesia, normal urine output (1–2 mL/
kg/H) represents adequate kidney perfusion and assumes
proper perfusion of other organs as well. For patients
with renal failure, severe dehydration, or acute hemor-
rhage, it is important to monitor and check urine output
during surgery and recovery. If a urinary catheter is not
preplaced, palpation of the animal’s bladder or visual
estimation of the volume of urine voided can provide a
crude estimate of urine production.
Lack of urine production represents hypoperfusion of
the kidneys and other tissues, as well as possible kidney
failure. Until adequate urine production is achieved,
rehydration and an inotropic agent may be used to treat
hypotension or tissue hypoperfusion during anesthesia
and the recovery period. Patients that have low urine
output with normal tissue perfusion and blood pressure
may be in renal failure and might require treatment with
diuretics. ■

The next and final article in this series will discuss

corrective actions necessary to address abnormalities
detected by anesthetic monitoring equipment in order
to achieve the goal of safe anesthesia.

BP = blood pressure; co2 = carbon dioxide; ecg = elec-

trocardiography; eTco2 = end-tidal carbon dioxide; MAc =
minimal alveolar concentration; Paco2 = partial pressure of
co2 in arterial blood; Pao2 = partial pressure of oxygen in
arterial blood; Pco2 = partial pressure of co2; PcV = packed
cell volume; Pvco2 = partial pressure of co2 in venous
blood; sao2 = percentage of available hemoglobin saturated
with oxygen; spo2 = saturation level of oxygen in hemoglobin
as measured by pulse oximetry

References
1. Cilley re, Scharenberg AM, Bongiorno PF, et al. Low oxygen delivery
produced by anemia, hypoxia, and low cardiac output. J Surg Res 1991;
51(5):425-433.
2. Marx G, reinhart K. venous oximetry. Curr Opin Crit Care 2006; 12(3):263-
268.
3. Mellema M. Cardiac output, wedge pressure, and oxygen delivery. Vet Clin
North Am Small Anim Pract 2001; 31(6):1175-1205.
4. Allen Se, Holm JL. Lactate: Physiology and clinical utility. J Vet Emerg Crit
Care 2008; 18(2):123-132.
5. Tas O, de rooster H, Baert e, et al. The accuracy of the Lactate Pro hand-
held analyser to determine blood lactate in healthy dogs. J Small Anim
Pract 2008; 49(10):504-508.

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