Physiologic Monitoring: Improving Safety or Increasing Risk?

This paper will present a focused and personal history of physiologic monitoring, beginning with the discovery of modern anesthesia and its development from a technical practice to a scientific discipline. Emphasis will be on the essence of monitoring in the anesthesia evolution, and this work will attempt to answer the question of how to evaluate the impact of monitoring on patient outcome. Understanding that monitors are passive and that only caregivers using monitors can impact outcome is at the crux of this approach to analysis. The limited quality data involving monitoring analysis, including that from pulse oximetry, will be discussed and critiqued. The invention and rapid spread of pulse oximetry will be highlighted and used as an example throughout, but the principles developed will apply to other monitors and patient monitoring in general. The problems created by monitoring alarms will also be discussed.