Advanced Monitoring Is Associated with Fewer Alarm Events During Planned Moderate Procedure-Related Sedation

Lenart, John; Malkin, Mathew; Meineke, Minhthy N.; Qoshlli, Silvana; Jacobson, Paul H.; Kruger, Alison; Ching, Jeffrey; Hassanian, Mohammad; Um, Michael

doi:10.1213/ane.0000000000001160

Cited by 14 publications

(7 citation statements)

References 59 publications

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“…This novel monitor detected airway obstruction before capnography and prolonged the time from detection of obstruction to desaturation. Patients who receive supplemental oxygen can have normal pulse oximetry signal even after the loss of P ETCO 2 due to obstructive apnea [11][12][13]. This is contrary to our results, however, and may be due to the short duration and low flow of supplementary oxygen which were inadequate to compensate hypoventilation in our patient population.…”

Section: Discussioncontrasting

confidence: 99%

Synchronized mandibular movement and capnography: a novel approach to obstructive airway detection during procedural sedation—a post hoc analysis of a prospective study

Coeckelenbergh

Engelman

Tuna

et al. 2019

J Clin Monit Comput

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Perioperative complications related to obstructive sleep apnea still occur despite the use of partial pressure end-tidal CO 2 P ETCO 2 and pulse oximetry. Airway obstruction can complicate propofol sedation and a novel monitor combining mandibular movement analysis with capnography may facilitate its detection. Patients scheduled for sleep endoscopy were recruited and monitored with standard monitoring, P ETCO 2 , and Jaw Activity (JAWAC) mandibular movement sensors. A post hoc analysis investigated airway obstruction prediction using a Respiratory Effort Sequential Detection Algorithm (RESDA) based on P ETCO 2 and mandibular movement signals. 21 patients were recruited and 54 episodes of airway obstruction occurred. RESDA detected obstructive apnea [mean ± SD (median)] 29 ± 29 (21) s, p < 0.0001, before P ETCO 2 alone. This prolonged the time between obstructive apnea detection and decrease to 90% oxygen saturation 64 ± 38 ( 54) versus 38 ± 20 (35) s, p < 0.0001. It predicted airway obstruction with a sensitivity and specificity of 81% and 93%, respectively. The RESDA algorithm, which is based on the combination of capnography with mandibular movement assessment of respiratory effort, can more rapidly alarm anesthetists of airway obstruction during propofol sedation than P ETCO 2 alone. However, P ETCO 2 , pulse oximetry, and clinical monitoring are still required. Trial Registry numbers: ClinicalTrial.gov (NCT02909309) https ://clini caltr ials.gov/ct2/show/NCT02 90930 9.

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Section: Discussioncontrasting

confidence: 99%

Synchronized mandibular movement and capnography: a novel approach to obstructive airway detection during procedural sedation—a post hoc analysis of a prospective study

Coeckelenbergh

Engelman

Tuna

et al. 2019

J Clin Monit Comput

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“…The primary outcome was the incidence of decreased SpO 2 92% observed during the interval between the start of sedation and the end of the procedure. Although hypoxaemia is often defined as SpO 2 <90%, we chose, as other researchers did, 19,20,25,26 the 92% threshold considering that in patients breathing an FiO 2 of at least 0.50 (as planned per protocol), this would reflect clinically significant oxygenation impairment. SpO 2 and heart rate were recorded every minute during the procedure by the usual anaesthesia multiparameter monitor (Datex Ohmeda or Carescape B450 or Carescape B650; General Electric Healthcare, Chicago, IL, USA).…”

Section: Discussionmentioning

confidence: 99%

High-flow nasal oxygenation or standard oxygenation for gastrointestinal endoscopy with sedation in patients at risk of hypoxaemia: a multicentre randomised controlled trial (ODEPHI trial)

Nay

Fromont

Eugene

et al. 2021

British Journal of Anaesthesia

120

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Background: We aimed to determine whether high-flow nasal oxygen could reduce the incidence of decreased peripheral oxygen saturation (SpO 2 ) compared with standard oxygen in patients at risk of hypoxaemia undergoing gastrointestinal endoscopy under deep sedation. Methods: This was a multicentre, randomised controlled trial with blinded assessment of the primary outcome evaluating high-flow nasal oxygen (gas flow 70 L min À1 , inspired oxygen fraction 0.50) or standard oxygen delivered via nasal cannula or face mask (6 L min À1 ) or nasopharyngeal tube (5 L min À1 ) in patients at risk of hypoxaemia (i.e. >60 yr old, or with underlying cardiac or respiratory disease, or with ASA physical status >1, or with obesity or sleep apnoea syndrome) undergoing gastrointestinal endoscopy. The primary endpoint was the incidence of SpO 2 92%. Secondary outcomes included prolonged or severe desaturations, need for manoeuvres to maintain free upper airways, and other adverse events. Results: In 379 patients, a decrease in SpO 2 92% occurred in 9.4% (18/191) for the high-flow nasal oxygen group, and 33.5% (63/188) for the standard oxygen groups (adjusted absolute risk difference, e23.4% [95% confidence interval (CI), e28.9 to e16.7]; P<0.001). Prolonged desaturation (>1 min) and manoeuvres to maintain free upper airways were less frequent in the high-flow nasal oxygen group than in the standard oxygen group (7.3% vs 14.9%, P¼.02, and 11.1% vs 32.4%, P<0.001). Conclusions: In patients at risk of hypoxaemia undergoing gastrointestinal endoscopy under deep sedation, use of highflow nasal oxygen significantly reduced the incidence of peripheral oxygen desaturation. Clinical trial registration: NCT03829293.

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“…This difference might be explained by the use of an earlier version of PSI-calculating algorithm in these studies. Unfortunately, no recently published studies reported which PSI algorithm was used [18][19][20] with the exception of one [21,22]. In recently published studies, baseline PSI values were reported to range between 84 and 95, although data generally appear only in figures [19,23].…”

Section: Discussionmentioning

confidence: 99%

Normative values for SedLine-based processed electroencephalography parameters in awake volunteers: a prospective observational study

Belletti

Naorungroj

Yanase

et al. 2020

J Clin Monit Comput

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Processed electroencephalography (pEEG) is used to monitor depth of anaesthesia and/or sedation. A novel device (Sed-Line®) has been recently introduced into clinical practice. However, there are no published data on baseline SedLine values for awake adult subjects. We aimed to determine baseline values for SedLine-derived parameters in eyes-open and eyes-closed states. We performed a prospective observational study in healthy volunteers. SedLine EEG-derived parameters were recorded for 2 min with eyes closed and 8 min with eyes open. We determined the overall reference range for each value, as well as the reference range in each phase. We investigated changes in recorded parameters between the two phases, and the interaction between EMG, baseline characteristics, and Patient State Index (PSI). We collected data from 50 healthy volunteers, aged 23-63 years. Median PSI was 94 (92-95) with eyes open and 88 (87-91) with eyes closed (p < 0.001 for open versus close). EMG activity decreased from 47.2% (46.6-47.9) with eyes open to 28.6% (28.0-29.3) with eyes closing (p < 0.001). There was a significant positive correlation between EMG and PSI with eyes closed (p = 0.01) but not with eyes open, which was confirmed with linear regression analysis (p = 0.01). In awake volunteers, keeping eyes open induces significant changes to SedLine-derived parameters, most likely due to increased EMG activity (e.g. eye blinking). These findings have implications for the clinical interpretation of PSI parameters and for the planning of future research.

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Advanced Monitoring Is Associated with Fewer Alarm Events During Planned Moderate Procedure-Related Sedation

Abstract: Supplemental Digital Content is available in the text.Published ahead of print February 1, 2016

Cited by 14 publications

References 59 publications

Synchronized mandibular movement and capnography: a novel approach to obstructive airway detection during procedural sedation—a post hoc analysis of a prospective study

Synchronized mandibular movement and capnography: a novel approach to obstructive airway detection during procedural sedation—a post hoc analysis of a prospective study

High-flow nasal oxygenation or standard oxygenation for gastrointestinal endoscopy with sedation in patients at risk of hypoxaemia: a multicentre randomised controlled trial (ODEPHI trial)

Normative values for SedLine-based processed electroencephalography parameters in awake volunteers: a prospective observational study

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