Nasal cannula with graphic display of respiratory rate and pattern is the most sensitive detector of respiratory depression during therapeutic endoscopy

J. Vargo, G. Zuccaro, J. Ryckman, D. Conwell

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Previous studies have suggested that measurement of transcutaneous CO2 (TCO2) is the most accurate indicator of oversedation during upper endoscopy. However, TCO2 is cumbersome and not practical for clinical use. Purpose: To determine if a nasal cannula with a sidestream CO2 detector is a more sensitive indicator of oversedation than standard monitoring techniques. Methods: Patients having therapeutic upper endoscopy underwent standard monitoring. Additionally, nasopharyngeal carbon dioxide measurements were obtained using a sidestream CO2 detector and a nasal cannula as a sampling device. This method provides graphic display of respiratory rate and pattern as well as continuous CO2 monitoring. Both endoscopist and nursing personnel were blinded to the CO2 values and graphic display. Apnea was defined as the absence of respiration for > 10 seconds. The occurrence of apneic episodes was compared to the frequency with which pulse oximetry, CO2 monitoring, and nursing personnel detected a compromise in the patient's respiratory status. Results: A total of 47 apneic episodes occurred in four of eight patients with a mean duration of 24.6 seconds (range 10-100 seconds, median 19 seconds). Total No. Apneic Episodes No. Episodes Detected by Pulse Oximetry (%) No. Episodes Detected by Co2 Monitor (%) No. Episodes Detected by Nursing Personnel (%) 47 2 (4%) 0 (0%) 2 (4%) Ten apneic episodes 40 seconds or greater in duration were not detected by nursing personnel, pulse oximetry and CO2 monitoring. Conclusions: 1) Apneic episodes occur frequently during therapeutic upper endoscopy 2) Current monitoring techniques for sedation and analgesia are inadequate to detect apnea. 3) Graphic display of the respiratory rate and pattern is a more sensitive indicator of respiratory depression than CO2 monitoring.

Original languageEnglish
Pages (from-to)AB60
JournalGastrointestinal Endoscopy
Volume47
Issue number4
StatePublished - 1998

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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