Capnographic monitoring of ventilatory status during moderate (conscious) sedation

  • L. G. Koniaris
  • S. Wilson
  • G. Drugas
  • W. Simmons
Original article


Background: Moderate (conscious) sedation is required to perform endoscopic procedures. Capnography provides a means for continuous, real-time monitoring of ventilation and may also decrease the incidence of oversedation. Methods: A retrospective examination of all endoscopic procedures performed from January through December 2001 at our institution was undertaken to determine the potential benefits of capnographic monitoring. Results: In 4,846 endoscopic procedures performed without capnography, adverse outcomes related to moderate sedation were noted in 14 cases (0.29%). A subset of patients at higher risk for moderate sedation was identified. There were no cases of oversedation in 600 cases monitored with capnography. The complication rates were not significantly different for the two groups (p = 0.30, NS). Conclusion: The addition of capnography during moderate sedation endoscopy does not appear to significantly lower anesthesia-related morbidity. However, in cases requiring moderate sedation for prolonged procedures, in older patients with comorbidities, or in instances where respiratory excursion of the patient is obscured from view, practitioners should nonetheless consider capnography.


Capnography Sedation Anesthesia Ventilation monitoring Respiratory status Endoscopic surgery 


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  1. 1.
    American Academy of Pediatrics Committee on Drugs1992Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures.Pediatrics8911101115PubMedGoogle Scholar
  2. 2.
    American Academy of Pediatrics Committee on DrugsAmerican Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists1996Practice guidelines for sedation and analgesia by nonanesthesiologists.Anesthesiology84459471PubMedGoogle Scholar
  3. 3.
    Bailey, PL, Pace, NL, Ashburn, MA, Tarver, SD, Varvel, J, Stanley, T 1990Frequent hypoxemia and apnea after sedation with midazolam and fentanyl.Anesthesiology73826830PubMedGoogle Scholar
  4. 4.
    Bowe, EA, Boysen, PG, Broone, JA, Klein Jr, EF 1989Accurate determination of end-tidal carbon dioxide during administration of oxygen by nasal cannulae.J Clin Monit5105110PubMedGoogle Scholar
  5. 5.
    American Academy of Pediatrics Committee on DrugsAmerican Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-AnesthesiologistsCouncil of Scientific Affairs, American Medical Association1993The use of pulse oximetry during conscious sedation.JAMA27014631468Google Scholar
  6. 6.
    Derrick, S, Waters, H, Kang, S, Cwalina, T, Simmons, W 1993Evaluation of a nasal/oral discriminate sampling system for capnographic respiratory monitoring.AANAJ61509520Google Scholar
  7. 7.
    Eichhorn, JH 1991ASA Standards amend: CO2 seen after intubation now the ‘standard of care’.Anesthesia Patient Safety Foundation Newsletter6112Google Scholar
  8. 8.
    Gleeson, K, Zwillich, CW, Braier, K, White, DP 1986Breathing route during sleep.Am Rev Respir Dis13115120Google Scholar
  9. 9.
    Goldman, JM 1987A simple, easy, and inexpensive method for monitoring ETCO2 through nasal cannulae.Anesthesiology67606Google Scholar
  10. 10.
    Iwasaki, J, Vann, WF, Dilley, DC, Anderson, JA 1989An investigation of capnography and pulse oximetry as monitors of pediatric patients sedated for dental procedures.Pediatr Dentist11111117Google Scholar
  11. 11.
    Kempen, P 1999Cost-efficient end-tidal carbon dioxide monitoring via Hudson-style mask.Anesthesiology9111761177CrossRefGoogle Scholar
  12. 12.
    Litman, RS, Berkowitz, RJ, Ward, DS 1996Levels of consciousness and ventilatory parameters in young children during sedation with oral midazolam and nitrous oxide.Arch Pediatr Adolesc Med150665677PubMedGoogle Scholar
  13. 13.
    Lui, SY, Lee, TS, Bongard, F 1992Accuracy of capnography in nonintubated surgical patients.Chest10215121515PubMedGoogle Scholar
  14. 14.
    McQuillen, KK, Steele, DW 2000Capnography during sedation/analgesia in the pediatric emergency department.Pediatr Emerg Care16401404CrossRefPubMedGoogle Scholar
  15. 15.
    Tobias, JD, Kavenaugh-McHugh, A 1995Oximetry and capnography during sedation for transesophageal echocardiography.Clin Pediatr34565566Google Scholar
  16. 16.
    Wright, S 1992Conscious sedation in the emergency department: the value of capnography and pulse oximetry.Ann Emerg Med21551555PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • L. G. Koniaris
    • 1
  • S. Wilson
    • 2
  • G. Drugas
    • 1
  • W. Simmons
    • 2
  1. 1.Department of SurgeryUniversity of Rochester School of Medicine and Dentistry, Box Surg, 601 Elmwood Avenue, Rochester, NY 14562USA
  2. 2.Department of AnesthesiologyUniversity of Rochester School of Medicine and Dentistry, Rochester, NY 14562USA

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