charting...dialed in or end tidal?

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Quick question for SRNA's or CRNA's...When charting concentration of the anesthetic agent, do you chart what's dialed in or end tidal concentration? There seems to be mixed opinions among the CRNA's at the hospital where I am doing my clinicals. I have heard the pros and cons of both. What's the right way?

End tidal is the most accurate method; however, the dialed in will be more easily defended in a lawsuit. An example is an end tidal of 2.5 and the patient's CO drops from 5.0 to 1.2. You want to lighten the anesthetic immediatly, but because of the diminished uptake of agent, your end tidal never changes. If you charted dialed in then you would note that you turned agent down signifigantly. It may not be the most accurate, but is a more accurate record of what you are acctually doing and is easier to defend without going into FA and FI, solubility coefficients, and physiology.

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End tidal here

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I don't document the vaporizer setting; I do document the FI and end-tidal concentrations as measured by mass spectrometry. Also document liter flow rates of air/oxygen/nitrous oxide--whatever the combination is for that case and FIO2

PG

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We are taught to monitor end tidal concentrations also

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