Volumetric Capnography for Respiratory Monitoring of Patients During Routine Colonoscopy With Room-Air and Carbon Dioxide Insufflation

Abstract

Background: Capnography and carbon dioxide (CO2) insufflation during gastrointestinal endoscopy under sedation are associated with safety and comfort improvements, respectively. Capnography can provide early detection of apnea and hypoxemia, whereas CO2 insufflation causes lower periprocedural discomfort. This is the first study to report the application of volumetric capnography in colonoscopy. Objective: This study aimed to evaluate the use of volumetric capnography with room air (RA) and CO2 insufflation during routine colonoscopy. Methods: In this prospective cohort study, 101 patients who underwent routine colonoscopy under sedation with volumetric capnography monitoring were included. Insufflation with RA was used to distend the intestinal lumen in group 1 (n=51), while group 2 (n=50) used CO2 insufflation. The primary endpoints were episodes of hypoxia, alveolar hypoventilation, and end-tidal CO2 (EtCO2). The secondary endpoints were tidal volume per minute, consumption of sedation medications, and post-procedure pain using the Gloucester modified pain scale. Results: The number of episodes of hypoxia (SpO2<90%) was similar between the groups: four episodes in Group 1 and two episodes in Group 2. The duration of hypoxia was significantly longer in group 2 (P=0.02). Hypoalveolar ventilation (EtCO2) occurred more frequently in Group 2 than in Group 1 (27 vs 18 episodes, P=0.05). Regarding EtCO2, Group 2 showed higher values in cecal evaluation (28.94±4.68 mmHg vs 26.65±6.12 mmHg, P=0.04). Regarding tidal volume per minute, Group 2 had significantly lower values at the cecal interval compared to Group 1 (2027.53±2818.89 vs 970.88±1840.25 L/min, P=0.009). No episodes of hypercapnia (EtCO2 > 60 mmHg) occurred during the study. There was no difference in the consumption of sedation medications between the groups. Immediately after colonoscopy, Group 2 reported significantly less pain than Group 1 (P=0.05). Conclusion: In our study, volumetric capnography during colonoscopy was feasible and effective for monitoring ventilatory parameters and detecting respiratory complications. CO2 insufflation was safe and associated with less pain immediately after colonoscopy.

Comparison of patient-controlled analgesia and sedation (PCAS) with remifentanil and propofol versus total intravenous anesthesia (TIVA) with midazolam, fentanyl, and propofol for colonoscopy

“…[ 17 ] These complications attributed to sedation may exceed technical complications by a factor of 10. [ 18 ] Previous studies indicated that patients would be helped by shorter discharge time and reduced sedation with a patient–control sedation protocol, either with propofol–alfentanil PCS or midazolam–pethidine regimens. [ 19 ] In our current study, the PCAS procedure administered with remifentanil and propofol led to a faster recovery time compared to the TIVA approach.…”

An Optical Micro/Nano Fiber Sensor for Monitoring Respiration

“…For gastrointestinal endoscopy, routine anesthesia monitoring includes blood pressure and oxygen saturation. However, statistics show that the probability of respiratory complications during anesthesia is as high as 20-30% [1][2][3][4]. Therefore, it is necessary to develop a low-cost device for real-time and continuous-concentration endtidal carbon dioxide (CO 2 ) monitoring.…”

An Optical Micro-nano fiber Sensor Monitoring Exhaled Carbon Dioxide Gas

“…For gastrointestinal endoscopy, routine anesthesia monitoring includes blood pressure and oxygen saturation. However, statistics show that the probability of respiratory complications during anesthesia is as high as 20-30% [1][2][3][4]. Therefore, it is necessary to develop a low-cost device for real-time and continuous concentration of end-tidal carbon dioxide monitoring.…”