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• W2079751539 abstract "We read with interest Wilkinson and Thanawala’s letter [1] on the flaws in the use of thoracic impedance monitoring during sedation and the conclusion that side-stream capnographic monitoring is essential during sedation. End-tidal CO2 monitoring is already considered to be essential monitoring during general anaesthesia but as yet only pulse oximetry, non invasive blood pressure monitoring and ECG are considered essential in sedation. With local research and development committee approval, and chairman’s action by the Local Research Ethics Committee, for 2 years we have been using a modified bite guard adapted to allow delivery of nasal oxygen and capnographic monitoring during Endoscopic Retrograde Cholangiopancreatography (ERCP). ERCP is a technically difficult and often long procedure made more challenging by patient movement during sedation. Use of end-tidal CO2 monitoring combined with propofol target controlled infusions has enabled us to achieve a high procedure completion rate (95.9%). We examined the accuracy of the capnographic bite guard with thoraco-abdominal impedance measurement. This latter, unlike the purely thoracic impedance monitoring described in the previous letter, measures both abdominal and respiratory effort and is able to detect the seesaw inspiratory pattern of airway obstruction. It is considered the gold standard for detection of airway obstruction in sleep studies. Thirty five patients were monitored by thoraco-abdominal impedance monitoring, end tidal CO2 monitoring, ECG, pulse oximetry and non-invasive blood pressure monitoring. The study demonstrated that CO2 monitoring was a better detector of apnoea with a faster response time than pulse oximetry. The capnography wave was an accurate representation of the patient’s ventilatory status in 135 instances of 147 (91.8%). Procedural sedation in the Emergency Department is commonplace. It is used routinely for fracture and dislocation manipulation, cardioversion and wound management in paediatrics. The safety of this procedure is paramount and consideration must be given to the monitoring of the patient. Pulse oximetry measures oxygen saturation but this only provides a late alarm and may be adversely affected after an unreasonable depression has occurred in respiration. Mcquillen et al. [2] and Tobias [3] both found that end-tidal CO2 monitoring enabled the early detection of respiratory depression. Whilst Miner et al. [4] concluded that end-tidal CO2 enhanced safety and detected subclinical respiratory depression. Vargo et al. [5] looked at sedation in gastrointestinal endoscopy and demonstrated that pulse oximetry only picked up 50% of apnoea cases detected by capnography and took on average 46 s longer. They concluded that pulse oximetry and visual assessment could not detect early, subclinical and relevant signs of respiratory depression. We feel that there is a strong evidence base supporting the routine use of end-tidal CO2 monitoring for all sedation procedures allowing the early detection and rapid correction of apnoeic events and thereby enhancing patient safety." @default.
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• W2079751539 date "2009-08-03" @default.
• W2079751539 modified "2023-10-17" @default.
• W2079751539 title "Thoraco-abdominal impedance monitoring of respiratory rate during sedation" @default.
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• W2079751539 doi "https://doi.org/10.1111/j.1365-2044.2009.06041.x" @default.
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