While there are no guidelines for how to monitor patients on a PCA there are recommendations from the Anesthesia Patient Safety Foundation (APSF). The APSF advocates the use of continuous monitoring of oxygenation (i.e., pulse oximetry) and ventilation in patients receiving PCA. The reason for monitoring both oxygenation and ventilation is that pulse oximetry has reduced sensitivity as a monitor of hypoventilation when supplemental oxygen is administered. Therefore, especially when supplemental oxygen is used, monitoring of ventilation should be undertaken with a technology designed to assess breathing or estimate arterial carbon dioxide concentrations. Some type of continuous monitoring is most important for high-risk patients (i.e., elderly, obstructive sleep apnea, morbidly obese) but likely should be applied to all patients.
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