Abstract
In the evaluation of any medical technology the efficacy, effectiveness, and efficiency must each be considered before routine deployment is recommended. Since the widespread practice of patient monitoring by pulse oximetry and capnography has occurred before the performance of rigorously controlled trials, definitive proof of worth is lacking. The purpose of this review is to appraise critically the effectiveness of this technology. The assessment was performed using concepts developed in epidemiology and community medicine to establish a given factor to be causative to a given outcome. The current literature pertaining to anaesthetic adverse outcomes was reviewed, and the use of monitors evaluated against the criteria of a causal relationship. While the conclusions are based more on the absence of positive data (owing to low frequency of adverse anaesthetic occurrences) rather than negative results, it must be concluded that the effectiveness of such monitoring has yet to be demonstrated. Such a conclusion should not detract from their use, for the role of an individual factor in the complex chain of accident evolution will seldom be demonstrable. Rather, such an appraisal should encourage a clear perspective of the depth of our clinical science, and encourage more rigorous critical evaluation in the future.
Résumé
Dans l’évaluation de toute technologie medicale l’efficacité, l’opérabilité, et le rendement doivent etre considérés avant le déploiement de son emploi de routine. Etant donné que la pratique courante de la surveillance des patients par saturometrie de pouls et capnographie est survenue avant l’accomplissement d’essais rigoureux et contrôlés, la preuve de leur valeur nest pas encore établie. Le but de cette revue est d’évaluer d’une façon critique cette technologic L’évaluation fut faite utilisant des concepts développés en épidémiologie et médecine communautaire afin d’établir qu’un facteur donné est responsable d’une certaine issue. La littérature actuelle concernant l’issue anesthésique défavorable fut revue et l’utilisation des moniteurs évaluée afin d’établir la relation de cause à effet. Alors que les conclusions sont basees plus sur l’absence de données positives (à cause de la basse fréquence, des issues anesthésiques défavorables) plutôt que des résultats négatifs, on doit conclure que l’efficacité de ce genre de monitoring demeure encore à être démontrée. Une telle conclusion ne doit pas nous empêcher de les utiliser car le rôle dun facteur individuel dans une chaîne complexe d’accidents peut être rarement démontré. Cette évaluation devrait plutôt encourager une perspective claire sur notre science clinique et nous encourager à une évaluation plus rigoureuse et critique dans le futur.
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Duncan, P.G., Cohen, M.M. Pulse oximetry and capnography in anaesthetic practice: an epidemiological appraisal. Can J Anaesth 38, 619–625 (1991). https://doi.org/10.1007/BF03008199
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DOI: https://doi.org/10.1007/BF03008199