A systematic review of capnography for sedation

Abstract

SummaryWe included six trials with 2524 participants. Capnography reduced hypoxaemic episodes, relative risk (95% CI) 0.71 (0.56-0.91), p = 0.02, but the quality of evidence was poor due to high risks of performance bias and detection bias and substantial statistical heterogeneity. The reduction in hypoxaemic episodes was statistically homogeneous in the subgroup of three trials of 1823 adults sedated for colonoscopy, relative risk (95% CI) 0.59 (0.48-0.73), p < 0.001, although the risks of performance and detection biases were high. There was no evidence that capnography affected other outcomes, including assisted ventilation, relative risk (95% CI) 0.58 (0.26-1.27), p = 0.17.

Benefits and harms of capnography during procedures involving moderate sedation

“…We conducted 2 meta-analyses: 1 to update the meta-analysis in Waugh and colleagues 9 evaluating detection of adverse respiratory events and 1 to update the meta-analysis in Conway and colleagues 8 evaluating the risk of developing hypoxemia. Fixed-effects models would assume that the true effect of capnographic monitoring is the same in every study and that differences between study results are solely due to chance, whereas random-effects models relax this assumption and instead assume that the effect of capnographic monitoring for individual studies varies around some overall average effect.…”

“…Of these, 2 were relevant systematic reviews and metaanalyses. 8,9 The search strategies in these 2 articles were similar, excepting that Conway and colleagues 8 were less restrictive regarding patient population and publication language.…”

“…In February 2016, to update the existing systematic reviews, 8,9 we conducted systematic searches in PubMed and Google Scholar for clinical trials involving adult humans, limited to Englishlanguage articles published in the prior 10 years. This search strategy combined key words, synonyms, and subject headings for the concept capnography with key words, synonyms, and index terms for each of the following 2 concepts: (procedural sedation and analgesia or patient-controlled analgesia) or (ambulatory surgical procedures or biopsies or refractive surgical procedures or tracheostomy or tracheotomy or paracentesis or surgical procedures, minimally invasive or endoscopy or electroconvulsive therapy or electric countershock or debridement or ablation techniques or induced abortion or dental).…”

“…7 We performed a systematic review and meta-analysis to facilitate decision making about the need to use capnography routinely during moderate sedation of adults in dental practice. In this work, we include updates of 2 previously published systematic reviews 8,9 to include more recently published literature, use more conservative study inclusion and modeling methods, and exclude pediatric patients. The aim was to determine whether adding capnography to standard monitoring influences the risk of developing hypoxemia, adverse respiratory events, serious adverse events, quality of sedation, and patient satisfaction.…”

The safety and efficacy of dexmedetomidine-remifentanil in children undergoing flexible bronchoscopy

“…Third, we did not collect blood gas measurement or transcutaneous capnography in this trial, which may be more accurate to assess respiratory state of children undergoing flexible bronchoscopy. [37,38] Finally, we only discussed 3 different combinations of DEX-RF, studies should be carried out to verify the feasibility of more different doses of DEX-RF used in children undergoing flexible bronchoscopy in the future.…”