The value of end-tidal CO2 monitoring when comparing three methods of conscious sedation for children undergoing painful procedures in the emergency department

Hart, Lisa Sinclair; Berns, Scott D.; Houck, Constance S.; Boenning, Douglas A.

doi:10.1097/00006565-199706000-00004

Cited by 105 publications

(51 citation statements)

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“…End-tidal CO 2 and BIS have been used to model the 21 and ETCO 2 and pulse oximetry have been used to measure RD in patients undergoing PS. [7][8][9] End-tidal CO 2 has been shown to detect airway obstruction more quickly than pulse oximetry. 22 Nasal-sample ETCO 2 has been shown to correlate well with blood partial pressure of carbon dioxide (pCO 2 ) in patients with unobstructed airways, 24 while airway obstruction and hypoventilation have been shown to produce ETCO 2 values that are lower than blood values.…”

Section: Discussionmentioning

confidence: 99%

“…These criteria are an adaptation of criteria that have been used to define RD in previous studies that used ETCO 2 in PS. [7][8][9] After the procedure the physician noted any complications, including but not limited to: vomiting or aspiration, intubation, transfers to a higher level of care after the procedure, hypotension, arrhythmias, and whether the patient required assisted ventilations (by bag-valve-mask) due to decreased protective airway reflexes during the procedure. The duration of any assisted ventilations was also recorded.…”

Section: Methodsmentioning

confidence: 99%

“…Several studies have suggested that the use of end-tidal carbon dioxide (ETCO 2 ) monitoring during procedural sedation allows for a surrogate measure of RD that detects subclinical RD earlier than was possible using standard monitoring alone. [7][8][9] It is possible that such a strategy will still bring patients closer to the point of RD and possible complications than is necessary for adequate sedation. Alternatively, it is possible that patients may be receiving inadequate sedation when an increase in the depth of the sedation would present minimal additional risk.…”

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confidence: 99%

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Bispectral Electroencephalographic Analysis of Patients Undergoing Procedural Sedation in the Emergency Department

Miner

Biros

Heegaard

et al. 2003

Academic Emergency Medicine

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Objective: To determine whether there is a correlation between the level of sedation achieved during procedural sedation (PS) in the emergency department as determined by bispectral electroencephalographic (EEG) analysis (BIS) and the rate of respiratory depression (RD), the patient's perception of pain, recall of the procedure, and satisfaction. Methods: This was a prospective observational study conducted in an urban county hospital of adult patients undergoing PS using propofol, methohexital, etomidate, and the combination of fentanyl and midazolam. Consenting patients were monitored by vital signs, pulse oximetry, nasal-sample end-tidal carbon dioxide (ETCO 2 ), and BIS monitors during PS. Respiratory depression (RD) was defined as an oxygen saturation \90%, a change from baseline ETCO 2 of [10 mm Hg, or an absent ETCO 2 waveform at any time during the procedure. After the procedure, patients were asked to complete three 100-mm visual analog scales (VASs) concerning their perception of pain, recall of the procedure, and satisfaction with the procedure. Patients were divided into four groups based on the lowest BIS score recorded during the procedure, group 1, [85; group 2, 70-85; group 3, 60-69; group 4, \60. Rates of RD and VAS outcomes were compared between groups using chi-square statistics. Results: One hundred eight patients were enrolled in the study. No serious adverse events were noted. RD was seen in three of 14 (21.4%) of the patients in group 1, seven of 34 (20.6%) in group 2, 16 of 26 (61.5%) in group 3, and 18 of 34 (52.9%) in group 4. The rate of RD in patients in group 2 was not significantly different from that in group 1 (p ¼ 0.46). The rate of RD in group 2 was significantly lower than that in groups 3 (p ¼ 0.0003) and 4 (p ¼ 0.006). For the VAS data, when group 1 was compared with the combined groups 2, 3, and 4, it had significantly higher rates of pain (p ¼ 0.003) and recall (p ¼ 0.001), and a dissatisfaction rate (p ¼ 0.085) that approached significance. When groups 2, 3, and 4 were compared with chi-square test, there was not a significant difference in pain (p ¼ 0.151), recall (p ¼ 0.27), or satisfaction (p ¼ 0.25). Conclusions: Patients with a lowest recorded BIS score between 70 and 85 had the same VAS outcomes as more deeply sedated patients and the same rate of RD as less deeply sedated patients. This range of scores represented the optimally sedated patients in this study.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Bispectral Electroencephalographic Analysis of Patients Undergoing Procedural Sedation in the Emergency Department

Miner

Biros

Heegaard

et al. 2003

Academic Emergency Medicine

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“…The use of a precordial stethoscope or capnograph for patients who are difficult to observe (eg, during MRI or in a darkened room) to aid in monitoring adequacy of ventilation is encouraged. 143 The practitioner shall document the name, route, site, time of administration, and dosage of all drugs administered. The inspired concentrations of inhalation sedation agents and oxygen and the duration of administration shall be documented.…”

Section: Monitoringmentioning

confidence: 99%

Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update

Coté¹,

Wilson²

2006

Pediatrics

500

150

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The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical supervision; careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications; appropriate fasting for elective procedures and a balance between depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure; a focused airway examination for large tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction; a clear understanding of the pharmacokinetic and pharmacodynamic effects of the medications used for sedation, as well as an appreciation for drug interactions; appropriate training and skills in airway management to allow rescue of the patient; age-and size-appropriate equipment for airway management and venous access; appropriate medications and reversal agents; sufficient numbers of people to carry out the procedure and monitor the patient; appropriate physiologic monitoring during and after the procedure; a properly equipped and staffed recovery area; recovery to presedation level of consciousness before discharge from medical supervision; and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children. INTRODUCTIONInvasive diagnostic and minor surgical procedures on pediatric patients outside the traditional operating room setting have increased in the last decade. As a consequence of this change and the increased awareness of the importance of providing analgesia and anxiolysis, the need for sedation for procedures in physician offices, dental offices, subspecialty procedure suites, imaging facilities, emergency departments, and ambulatory surgery centers has also markedly increased. In recognition of this need for both elective and emergency use of sedation in nontraditional

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“…[58] Çocuklar üzerinde yapılan bir başka çalışmada klinik gözlem, pulsoksimetre ve ETCO 2 'nin solunum depresyonunu tespit etme başarıları karşılaştırılmış ve hastaların %75'inin sadece ETCO 2 takibi ile tespit edilebildiği rapor edilmiştir. [59] Başka bir çalışmada ETCO 2 ile hastaların %50'sinden fazlasında hipoventilasyon, %25'inde apne saptanması-na rağmen, bu sonuçlardan habersiz sağlık personeli klinik gözlem ve pulsokimetre ile hastaların hiçbirinde apne saptamazken, sadece %3'ünde hipoventilasyon bildirmişlerdir. [60] Acil serviste propofol uygulanan hastalarda kapnografi takibinin hipoksik olay sıklığı üzerine etkisini değerlendiren randomize kontrollü bir çalışmada, kapnografi grubunda %25 hipoksi gözlenirken, bu oran diğer grupta %42 olarak tespit edilmiştir.…”

Section: "Bu Takip Yeterli Midir? Buna Etco 2 Takibinin Eklenmesi Birunclassified

Capnography Use In The Emergency Department

Çınar

2011

Tr J Emerg Med

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ÖZETKarbondioksit kısmi basıncının solunum sırasında havayolundan ölçülmesine kapnografi denir. İnvaziv olmama avantajına sahip bu yöntemle hastanın metabolik durumu, perfüzyonu ve en önemlisi ventilasyonu hakkında anlık bilgi elde edilebilir. Güncel rehberlerde endotrakeal entübasyonun doğrulanmasında rutin olarak kullanılması önerilen kapnografinin acil serviste daha birçok potansiyel kullanım alanı bulunmaktadır. Bu derlemede, kapnografinin acil servis kullanım alanlarının tartışılması amaçlanmıştır. GirişKarbondioksit (CO 2 ) kısmi basıncının solunum sırasında havayolundan ölçülmesine kapnografi denir. [1] İnvaziv olmama avantajına sahip bu yöntemle hastanın metabolik durumu, perfüzyonu ve en önemlisi ventilasyonu hakkında anlık bilgi elde edilebilir. Anestezide hasta takibinde 20 yıldır rutin olarak kullanılan kapnografinin, [2] acil pratiğinde kullanımı ancak teknolojik gelişmelerin kızılötesi spektrofotometrik yön-temlerle CO 2 analizi yapılmasına olanak sağlamasıyla başla-mıştır. Çünkü bu yöntemle acil servis kullanımına uygun elde taşınabilir ve düşük maliyetli cihazlar üretilmesi mümkün olmuştur (Şekil 1). Acil serviste kapnografi kullanımı koroner perfüzyon basıncının bir göstergesi olarak Kardiyo Pulmoner Resüsitasyon (KPR) çalışmaları ile başlamış, [3] ancak ismini daha çok endotrakeal entübasyonun doğrulanmasıyla duyurmuştur. [4] Fakat son yıllarda acil serviste girişimsel sedasyon analjezi [5] başta olmak üzere, KPR etkinliğinin değer-lendirilmesi, [6] bilinci kapalı hastada ventilasyon takibi, [7] solunum hastalıklarının değerlendirilmesi [8] gibi birçok alanda kullanımı gündeme gelmiştir.Bu derlemenin amacı acil serviste kapnografi kullanım alanlarının detaylı bir şekilde tartışılmasıdır. Ancak bunun ön-cesinde, acil tıp için yeni olan bu konuda, altta yatan temel kavramların bilinmesine ihtiyaç vardır. Bu nedenle yazının ilk bölümleri okuyucu için sıkıcı olmamasına özen gösterilerek CO 2 fizyolojisi, CO 2 ölçüm yöntemleri, terminoloji ve teknoloji konularına ayrılmıştır. Temel Kavramlar CO 2 FizyolojisiAerobik metobolizmanın bir ürünü olarak dokularda üreti-len CO 2 pasif olarak dolaşıma geçer. Metabolizmayı artıran ateş, egzersiz, sepsis, travma, yanık vb. durumlar CO 2 üreti-mini, dolayısıyla atılan CO 2 miktarını da artırır. Bunun yanın-da metabolik ihtiyacın azaldığı hipotermi, sedasyon, paralizi gibi durumlarda üretilen ve atılan CO 2 miktarı da düşer. Dolaşımda CO 2 3 farklı şekilde taşınır. 1) HCO 3 formunda (%70-%80) 2) Plazma proteinlerine bağlı (%10-%20) (çoğunlukla hemoglobin) 3) Serbest olarak (%5-%10). Dolaşımın bozul-80

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The value of end-tidal CO2 monitoring when comparing three methods of conscious sedation for children undergoing painful procedures in the emergency department

Cited by 105 publications

References 0 publications

Bispectral Electroencephalographic Analysis of Patients Undergoing Procedural Sedation in the Emergency Department

Bispectral Electroencephalographic Analysis of Patients Undergoing Procedural Sedation in the Emergency Department

Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update

Capnography Use In The Emergency Department

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