Quote from: ether_screen on January 26, 2005, 02:07:53 AM
ECG monitoring is a standard of care set forth by both the ASA and AANA.  Its' application requires all of 15 seconds, costs almost nothing, and has an unquestionable risk/benefit ratio.  I'm surprised some providers consider omission of this technology an option.

Routine ECG monitoring of a healthy heart provides no useful information and can be distracting to the point of causing death.
True example, from the days before routine EtCO2  and SpO2 monitoring and when hanging ventilator bellows were common place:
A poorly supervised very 'young' trainee did not recognize a circuit disconnect during an abdominal surgical procdure on a healthy 30 some year old. As he had been taught, the trainee treated bradycardia with atropine, all the time paying more attebtion to the ECG than to anything else.  The patient did not survive her hypoxic brain damage.
Such an incident is unlikely to occur today in a well equipt OR, but attending to  abberrent  ECG tracings  in  normal patients  can still  be a dangerous distraction.  When anesthesia has to be given "in the field", the least used monitor is the ECG.

I doubt if increased metabolism from sux would decrease systemic arterial oxygenation, unless there was a pulmonary shunt present.
With an adequate FiO2, normal lungs are capable of fully oxygenating any desaturated venous blood.
I do not usually preoxgenate for an extended time.  High maternal arterial oxgen levels decreases utero-placental flow in order to protect the baby from premature closure of the ductus arteriosus, among other things.
Also, with lungs full of O2, pulse oximetry will not give an early warning of unrecognized esophageal intubation.  Important when working with trainees. I've seen a baby delivered by C-section before the SpO2 decreased, and the lungs were not being ventilated all that time! Why supress spontaneous ventilation with 100-200 mcg fentanyl before starting to de-nitrogenize the lungs?  You could probably accomplish the same amout of N2 washout in a fraction the time without fentanyl. And if delivery is delayed, narcotiization would have to be included in the differential diagnosis of a sluggish baby.  Rocuronium needs to be given in a fairly good size dose if tracheal intubation needs to be accomplished with a minimum of  'unprotected' time.  I wonder how much crosses the placenta, especially if the baby's acidotic?  Sux myalgias are rarely seen in parturients.