Pain management/editorialShould Capnographic Monitoring Be Standard Practice During Emergency Department Procedural Sedation and Analgesia? Pro and Con
Section snippets
The Evidence
Capnography uses a special nasal-oral cannula to continuously sample CO2 concentration in exhaled breath. From these measurements, the device plots an ongoing waveform and automatically calculates the maximum CO2 concentration in each breath (end-tidal CO2 [etco2]). Capnography thus provides objective breath-by-breath verification of the quality of ventilation, and its use is routine during operative anesthesia.2 Interpretation of CO2 waveforms (capnograms) is not as straightforward as reading
References (15)
- et al.
Does ETCO2 monitoring during emergency department procedural sedation and analgesia with propofol decrease the incidence of hypoxic events? a randomized, controlled trial
Ann Emerg Med
(2010) - et al.
Capnography for procedural sedation and analgesia in the emergency department
Ann Emerg Med
(2007) - et al.
Capnography and depth of sedation during propofol sedation in children
Ann Emerg Med
(2007) - et al.
The utility of supplemental oxygen during emergency department procedural sedation and analgesia with midazolam and fentanyl: a randomized controlled trial
Ann Emerg Med
(2007) - et al.
The utility of supplemental oxygen during emergency department procedural sedation and analgesia with propofol: a randomized controlled trial
Ann Emerg Med
(2008) - et al.
Supplemental oxygen during propofol sedation: yes or no [editorial]?
Ann Emerg Med
(2008) - et al.
Capnographic monitoring of respiratory activity improves safety of sedation for endoscopic cholangiopancreatography and ultrasonography
Gastroenterology
(2009)
Cited by (24)
Unscheduled Procedural Sedation: A Multidisciplinary Consensus Practice Guideline
2019, Annals of Emergency MedicineSafety and Efficacy of Remimazolam Compared With Placebo and Midazolam for Moderate Sedation During Bronchoscopy
2019, ChestCitation Excerpt :Potential limitations of this trial include the following: (1) The MOAA/S scale used patient responsiveness as a marker for ventilation, and this may overestimate ventilation. As vital signs did not correlate with MOAA/S scores in this study, other monitoring strategies, that is, end-tidal carbon dioxide (capnography), could have been included to monitor ventilation and predict respiratory depression or apnea.33-36 However, in a phase IIb study of remimazolam for colonoscopy, capnography did not demonstrate clinically meaningful changes with higher remimazolam doses.
Monitoring for Nonoperating Room Anesthesia
2017, Anesthesiology ClinicsCitation Excerpt :Capnography provides quantitative and qualitative information regarding the adequacy of ventilation.9 Studies of adult and pediatric patients undergoing NORA have shown that capnography detects hypopnea earlier that pulse oximeter and decreases the incidence of hypoxemia.10–14 Capnography provides quantitative and qualitative data.9
Managing propofol-induced hypoventilation
2015, Annals of Emergency MedicineCitation Excerpt :There have been strong arguments both for20,21 and against20,22 capnography for ED deep sedation, and this debate is beyond the scope of this article. We support this monitoring modality because its addition to standard sedation monitoring will provide the earliest possible warning of potential or impending airway and respiratory adverse events (Figure).20 Deitch et al17 found that capnography significantly reduced the frequency of hypoxia with propofol, with warnings a median of a full minute before hypoxia developed.
Routine capnographic monitoring is not indicated for all patients undergoing emergency department procedural sedation
2013, Annals of Emergency MedicineProcedural sedation and analgesia in the emergency department: Recommendations for physician credentialing, privileging, and practice
2011, Annals of Emergency Medicine
Supervising editor: Michael L. Callaham, MD
Dr. Callaham was the supervising editor on this article. Dr. Green did not participate in the editorial review or decision to publish this article.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.
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Publication date: Available online October 12, 2009.