Capnography Sensors Reduce Adverse Outcomes During Sedation

Capnography monitoring during gastrointestinal endoscopic procedures (GEP) with procedural sedation is associated with significant reduction in the risk of rescue events and death.

Researchers at NorthStar Anesthesia (Irving, TX, USA), Springfield Regional Medical Center (OH, USA) and Medtronic (Dublin, Ireland) conducted a retrospective data analysis of 258,262 inpatients and 3,807,151 outpatients undergoing GEP with sedation. Patients were clustered into four groups: pulse oximetry (SpO2) only; capnography only; SpO2 with capnography; and neither SpO2 nor capnography. Outcome measures were incidence of pharmacological rescue events--defined by administration of naloxone and/or flumazenil--and death.

The results revealed that for inpatients, capnography monitoring was associated with a 47% estimated reduction in odds of death at discharge, and a non-significant 10% estimated reduction in the odds of pharmacological rescue event at discharge. For outpatients, capnography monitoring was associated with a 61% estimated reduction in the odds of pharmacological rescue event at discharge, and a non-significant 82% estimated reduction in the odds of death. The study was published on November 28, 2017, in BMC Anesthesiology.

“The use of capnography during GEP with procedural sedation is associated with significant reductions in the risk of pharmacological rescue events in outpatients and death in inpatients,” concluded lead author Michael Jopling, MD, of NorthStar Anesthesia, and colleagues. “Despite the limitations of this retrospective data-based study, we believe the use of capnography during GEP performed with sedation should be recommended.”

GEP such as esophagogastroduodenoscopy (EGD), endoscopic retrograde cholangiopancreatography (ERCP), and colonoscopy are standard procedures for the diagnosis and therapy of gastrointestinal disorders, but can be associated with discomfort. To improve patient comfort, the use of sedation in these procedures is common, but may result in drug-induced airway obstruction, respiratory depression with hypoventilation, and hypoxemia. Using capnography to continuously monitor respiratory rate, end-tidal carbon dioxide (ETCO2) levels, and waveform pattern can allow for the near real-time assessment of ventilation.