Capnographic Monitoring of Respiratory Activity Improves Safety of Sedation for Endoscopic Cholangiopancreatography and Ultrasonography

Redesign of an Open-System Oxygen Face Mask With Mainstream Capnometer for Children

“…The intervention group had an 11% incidence of hypoxemia, significantly lower than the control group (25%, P ϭ .02). A similar study was replicated by Qadeer et al 17 in adult subjects undergoing elective endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography under procedural sedation.…”

Yesterday’s luxury – today’s necessity: end-tidal CO2 monitoring during conscious sedation

“…They showed a significantly reduced rate of hypoxia (46% vs 69%), defined as an oximetry reading \ 90% for 15 sec, and a reduced rate of severe hypoxia (15% vs 31%), defined as an oximetry reading = 85% regardless of duration. 6 While the level of sedation in the latter study was not quantified, the amounts of medication (meperidine 25-75 mg iv or fentanyl 25-75 lg iv with midazolam 2 mg iv plus additional doses as required) seemed to be compatible with targeting at least moderate sedation. In another randomized controlled trial, Deitch et al 7 evaluated the use of capnography during sedation in the emergency room using fentanyl or morphine plus propofol and achieving a median score of 4 on the RSS.…”

“…Ils ont montré une baisse significative de l'incidence d'hypoxie (46 % contre 69 %) définie par une mesure d'oxymétrie \ 90 % pendant 15 s et une diminution du pourcentage d'hypoxies sévères (15 % contre 31 %) définies par une mesure d'oxymétrie égale à 85 %, quelle qu'en soit la durée. 6 Alors que le niveau de sédation dans ce dernier groupe n'a pas été quantifié, les quantités de médicaments (mépéridine 25-75 mg IV, fentanyl 25-75 lg IV avec midazolam 2 mg IV plus des doses supplémentaires si nécessaire) ont semblé correspondre à un objectif minimum de sédation modérée. Dans une autre étude randomisée contrôlée, Deitch et coll.…”

Safe anaesthesia for ERCP

“…We favour this strategy, although we have encountered some difficulties ensuring adequate supplemental oxygen delivery and reliable capnography monitoring. In particular, capnography is widely accepted to improve safety during deep sedation [5]. Absence of capnography may have contributed to the relatively high incidence of hypoxaemia presented by Gaitini et al…”

“…Even though the experience with the laryngeal tube and their variants is limited in the UK, as mentioned by Dr Toner and colleagues, the laryngeal tube and variants are widely used around the world, both for routine anaesthesia and emergency cases [4]. The European Resuscitation Council and the Advanced Trauma Life Support guidelines included the laryngeal tube in the algorithm for airway management [5,6]. We agree with Dr Toner and colleagues that patients for endoscopies are rigorously fasted so the risk of regurgitation and aspiration is low.…”