Capnographic monitoring of ventilatory status during moderate (conscious) sedation

Koniaris, Leonidas G.; Wilson, Stephen; Drugas, George T.; Simmons, Wayne R

doi:10.1007/s00464-002-8789-7

Cited by 27 publications

(7 citation statements)

References 12 publications

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“…in relation to the patients’ backgrounds, the type of sedative used, the primary outcome measure, etc.) [11–13]. To investigate the usefulness of end-tidal capnography during FB, prospective comparative trials are warranted in the future.…”

Section: Discussionmentioning

confidence: 99%

End-tidal capnographic monitoring to detect apnea episodes during flexible bronchoscopy under sedation

et al. 2017

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BackgroundApnea developing as a result of oversedation is a potential clinical problem in patients undergoing flexible bronchoscopy (FB) under sedation. However, there are no reports of evaluation using a standardized method of the frequency of occurrence of apnea episodes during FB under sedation. The aim of this study was to investigate the frequency of apnea episodes during FB under sedation in the clinical setting by end-tidal capnography.MethodsThis study was a single-institution retrospective review of a prospectively maintained database and medical records, including capnographic data, from April 2015 to March 2016. We enrolled patients who were sedated with midazolam and underwent diagnostic FB under end-tidal capnographic monitoring. Apnea was defined as cessation of airflow for more than 10 s.ResultsData from a total of 121 eligible patients were analyzed. A total of 131 apnea episodes (median duration 33 s) were recorded in 59 patients (48.8%). Prolonged apnea episodes lasting for more than 30 s occurred in 24 patients (19.8%). Furthermore, 55 apnea episodes (42.0%) were followed by a decline of the SpO2 by ≥4% from the baseline.ConclusionsIn this study, end-tidal capnography revealed the occurrence of apnea episodes at a high frequency in patients undergoing FB under sedation in the clinical setting.

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Section: Discussionmentioning

confidence: 99%

End-tidal capnographic monitoring to detect apnea episodes during flexible bronchoscopy under sedation

et al. 2017

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“…Other investigators, however, have failed to show a benefi t to patients when comparing ETC with PO for detecting RD. [9,20] With regard to ETC preventing hypoxia, Deitch et al [13][14][15] found hypoxia in 25% of patients monitored by ETC, compared with 42% of those where the sedationist was blinded to the ETC reading [difference of 17% (95%CI 1.3-33)]. They also noted that all cases of hypoxia were identified by ETC before onset (100% sensitivity) although 32/132 ETC monitored patients exhibited respiratory depression without going on to hypoxia [64% specifi city (95%CI 53%-73%)].…”

Section: Discussionmentioning

confidence: 99%

End-tidal capnometry during emergency department procedural sedation and analgesia: a randomized, controlled study

Campbell

Magee

Zed

et al. 2016

World Journal of Emergency Medicine

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BACKGROUND: This prospective, randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry (ETC) to pulse oximetry (PO) in patients undergoing procedural sedation and analgesia (PSA) in the emergency department (ED). METHODS:The patients were randomized to monitoring with or without ETC in addition to the current standard of care. Primary endpoints included respiratory adverse events, with secondary endpoints of level of sedation, hypotension, other PSA-related adverse events and patient satisfaction. RESULTS:Of 986 patients, 501 were randomized to usual care and 485 to additional ETC monitoring. In this series, 48% of the patients were female, with a mean age of 46 years. Orthopedic manipulations (71%), cardioversion (12%) and abscess incision and drainage (12%) were the most common procedures, and propofol and fentanyl were the sedative/analgesic combination used for most patients. There was no difference in patients experiencing de-saturation (SaO 2 <90%) between the two groups; however, patients in the ETC group were more likely to require airway repositioning (12.9% vs. 9.3%, P=0.003). Hypotension (SBP<100 mmHg or <85 mmHg if baseline <100 mmHg) was observed in 16 (3.3%) patients in the ETC group and 7 (1.4%) in the control group (P=0.048). CONCLUSIONS:The addition of ETC does not appear to change any clinically significant outcomes. We found an increased incidence of the use of airway repositioning maneuvers and hypotension in cases where ETC was used. We do not believe that ETC should be recommended as a standard of care for the monitoring of patients undergoing PSA.

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“…In addition, he reiterates the utility of capnography when the patient's respiratory excursions are not visible to the anesthesiologist [14]. This happens for example in an MRI where verbal stimulation, in order to assess the level of sedation, could affect the quality of the examination.…”

Section: Capnographymentioning

confidence: 99%

Capnography and the Bispectral Index—Their Role in Pediatric Sedation: A Brief Review

Sammartino

Volpe²,

Sbaraglia³

et al. 2010

International Journal of Pediatrics

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Sedation in children is increasingly emerging as a minimally invasive technique that may be associated with local anaesthesia or diagnostic and therapeutic procedures which do not necessarily require general anaesthesia. Standard monitoring requirements are not sufficient to ensure an effective control of pulmonary ventilation and deep sedation. Capnography in pediatric sedation assesses the effect of different drugs on the occurrence of respiratory failure and records early indicators of respiratory impairment. The Bispectral index (BIS) allows the reduction of dose requirements of anaesthetic drugs, the reduction in the time to extubation and eye opening, and the reduction in the time to discharge. In the field of pediatric sedation, capnography should be recommended to prevent respiratory complications, particularly in spontaneous ventilation. The use of the BIS index, however, needs further investigation due to a lack of evidence, especially in infants. In this paper, we will investigate the role of capnography and the BIS index in improving monitoring standards in pediatric sedation.

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Capnographic monitoring of ventilatory status during moderate (conscious) sedation

Cited by 27 publications

References 12 publications

End-tidal capnographic monitoring to detect apnea episodes during flexible bronchoscopy under sedation

End-tidal capnographic monitoring to detect apnea episodes during flexible bronchoscopy under sedation

End-tidal capnometry during emergency department procedural sedation and analgesia: a randomized, controlled study

Capnography and the Bispectral Index—Their Role in Pediatric Sedation: A Brief Review

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