Continuous real‐time ECG monitoring is an essential part of basic intra‐operative monitoring guidelines . However, the three‐lead ECG electrodes routinely placed in the Mason–Likar (M‐L) configuration (i.e. both infraclavicular fossae, and the anterior axillary line midway between the iliac crest and the costal margin) can encroach on the surgical field during anterior chest wall, upper abdominal and shoulder surgery. Further electrode relocation reduces their access by the anaesthetist, and risks misinterpretation .Takuma et al. suggest relocation to the anterior acromial region and anterior superior iliac spines bilaterally, but this is associated with abnormalities in R‐wave amplitude (specifically an increase in lead 2) .Instead, we have found that placing electrodes on the left and right sides of the forehead and a third anywhere below neck on the left side improves accessibility without detriment to ECG output morphology (Fig. ). With minor re‐adjustment, this configuration can be used successfully alongside processed electroencephalography electrodes.Suggested position of ECG electrodes.ReferencesAmerican Society of Anesthesiologists. Standards for basic anaesthetic monitoring 2016. https://www.asahq.org/~/media/Sites/ASAHQ/Files/Public/Resources/standards-guidelines/standards-for-basic-anesthetic-monitoring.pdf. (accessed 02/02/2018).Association of Anaesthetists of Great Britain and Ireland. Recommendations for standards of monitoring during anaesthesia and recovery 2015. Anaesthesia 2016; 71: 85–93.Jowett NI, Turner AM, Cole A, Jones PA. Modified electrode placement must be recorded when performing 12‐lead electrocardiograms. Postgraduate Medical Journal 2005; 81: 122–5.Takuma K, Hori S, Sasaki J, et al. An alternative limb lead system for electrocardiographs in emergency patients. American Journal of Emergency Medicine 1995; 13: 514–17.
Anaesthesia – Wiley
Published: Jan 1, 2018
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