Anesthesiologists routinely use capnography for both general anesthesia and sedation, considered the standard of care for sedation. This is not the case for nonanesthesiologists (e.g., specialists and nurses) administering deep sedation. Should it be? Does capnography use prevent hypoxemia?
Dr Kim van Loon, Division of Anesthesiology Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht, the Netherlands, and coauthors randomized over 400 adults undergoing minor gynecologic procedures to receive either capnography or only standard monitoring.
The results of their analysis are published in this month’s issue of Anesthesia & Analgesia in the article titled “Capnography During Deep Sedation with Propofol by Nonanesthesiologists: A Randomized Controlled Trial.”
The manuscript demonstrates that when patients breathe room air, capnography does not provide a notable “early warning” of impending hypoxemia during deep sedation with propofol. It shows that withholding supplemental oxygen to detect hypoventilation is a bogus concept. Withholding supplemental oxygen in sedation patients results in high levels of hypoxia. Even if patients are monitored with capnography, the incidence of hypoxia is unacceptable.