Maintenance of anaesthesia

Anaesthesia enables the performance of procedures otherwise intolerable to the patient. During the maintenance period, when such procedures take place, the anaesthetist performs many simultaneous tasks in a complex environment. These tasks include maintaining physiological homeostasis, prevention of awareness and facilitation of surgical activity. In particular, constant surveillance of the theatre environment (concentrating on the patient, monitoring and surgery) is pivotal to interpret observations in the context of the clinical situation and prompts the anaesthetist to intervene when necessary. Factors that may affect the quality and safety of maintenance of anaesthesia are the personnel administering the anaesthetic, environment, equipment available and skills, both technical and non-technical, of the anaesthetist. Critical incidents often occur during the maintenance period and human error is frequently implicated. Thus constant vigilance and strategies to prevent error and deal with crises are invaluable to the anaesthetist.