**5.1 Monitoring**

Monitoring in paediatric CHD is the same as in adult cardiac surgery but there are few differences and considerations during surgery. Monitoring during surgery ranges from simple ECG to blood glucose, which is controversial due to non availability of evidence that tight blood sugar control improves outcome16.

#### **5.1.1 Electrocardiogram**

Although ECG can be helpful in the detection of ST changes but is mainly used for arrhythmia detection in paediatric patients. Even arrhythmia detection is difficult due to baseline tachycardia. Skin should be prepared for electrode by rubbing with alcohol pad or swab. Three leads system is commonly used while in older children five leads system can also be used.

#### **5.1.2 Blood pressure monitoring**

#### **Non invasive monitoring**

Non invasive blood pressure should always be monitored even in the presence of arterial line. Cuff should be 20% wider than the diameter of limb where non invasive blood pressure is monitored. Smaller cuff results in erroneously high pressure while larger cuff will give lower pressures.
