Physiological Monitoring for Procedural Sedation: The Routine and Beyond
Chapter
First Online:
Abstract
Physiological monitoring of vital signs is essential for the safe practice of procedural sedation and analgesia. Oxygenation, ventilation, cortical activity, and hemodynamics can all be monitored noninvasively in spontaneously breathing patients. This chapter discusses the current guidelines and standards for patient monitoring and the essential monitoring modalities for procedural sedation and analgesia in children.
Keywords
Pulse Oximetry Deep Sedation Central Apnea Procedural Sedation Obstructive Apnea
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
References
- 1.Krauss B, Green SM. Procedural sedation and analgesia in children. Lancet. 2006;367:766–80.PubMedCrossRefGoogle Scholar
- 2.American Academy of Pediatrics, American Academy of Pediatric Dentistry. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics. 2006;118:2587–602.CrossRefGoogle Scholar
- 3.American Society of Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96:1004–17.CrossRefGoogle Scholar
- 4.American College of Emergency Physicians. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2005;45:177–96.CrossRefGoogle Scholar
- 5.Sedation and Anesthesia Care standards, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois. http://www.jcaho.org.
- 6.Krauss B, Green SM. Procedural sedation and analgesia in children. N Engl J Med. 2000;342:948–56.CrossRefGoogle Scholar
- 7.New W. Pulse oximetry. J Clin Monit. 1985;1:126.PubMedCrossRefGoogle Scholar
- 8.Alexander CM, Teller LE, Gross JB. Principles of pulse oximetry: theoretical and practical considerations. Anesth Analg. 1989;68:368–76.PubMedCrossRefGoogle Scholar
- 9.Tremper KK, Barker SJ. Pulse oximetry. Anaesthesiology. 1989;70:98–108.CrossRefGoogle Scholar
- 10.Sinex JE. Pulse oximetry: principles and limitations. Am J Emerg Med. 1999;17:59–67.PubMedCrossRefGoogle Scholar
- 11.Burton JH, Harrah JD, Germann CA, Dillon DC. Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices? Acad Emerg Med. 2006;13:500–4.PubMedCrossRefGoogle Scholar
- 12.Fu ES, Downs JB, Schweiger JW, Miguel RV, Smith RA. Supplemental oxygen impairs detection of hypoventilation by pulse oximetry. Chest. 2004;126:1552–8.PubMedCrossRefGoogle Scholar
- 13.Swedlow DB. Capnometry and capnography: the anesthesia disaster early warning system. Semin Anesth. 1986;3:194–205.Google Scholar
- 14.Smalhout B, Kalenda Z. An Atlas of Capnography. The Netherlands: Kerckebusch Zeist; 1975.Google Scholar
- 15.Colman Y, Krauss B. Microstream capnography technology: a new approach to an old problem. J Clin Monit. 1999;15:403–9.CrossRefGoogle Scholar
- 16.Friesen RH, Alswang M. End-tidal PCO2 monitoring via nasal cannulae in pediatric patients: accuracy and sources of error. J Clin Monit. 1996;12(2):155–9.PubMedCrossRefGoogle Scholar
- 17.Gravenstein N. Capnometry in infants should not be done at lower sampling flow rates. J Clin Monit. 1989;5:63–4.PubMedCrossRefGoogle Scholar
- 18.Sasse FJ. Can we trust end-tidal carbon dioxide measurements in infants? J Clin Monit. 1985;1:147–8.PubMedCrossRefGoogle Scholar
- 19.Berengo A, Cutillo A. Single-breath analysis of carbon dioxide concentration records. J Appl Physiol. 1961;16:522–30.Google Scholar
- 20.Krauss B, Deykin A, Lam A, Ryoo JJ, Hampton DR, Schmitt PW, et al. Capnogram shape in obstructive lung disease. Anesth Analg. 2005;100:884–8.PubMedCrossRefGoogle Scholar
- 21.Hoffbrand BI. The expiratory capnogram: a measure of ventilation-perfusion inequalities. Thorax. 1966;21:518–23.PubMedCrossRefGoogle Scholar
- 22.Yamanaka MK, Sue DY. Comparison of arterial-end-tidal PCO2 difference and dead space/tidal volume ratio in respiratory failure. Chest. 1987;92:832–5.PubMedCrossRefGoogle Scholar
- 23.Hardman JG, Aitkenhead AR. Estimating alveolar dead space from the arterial to end-tidal CO2 gradient: a modeling analysis. Anesth Analg. 2003;97:1846–51.PubMedCrossRefGoogle Scholar
- 24.Krauss B, Hess DR. Capnography for procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2007;50:172–81.PubMedCrossRefGoogle Scholar
- 25.Lumb AB, editor. Respiratory system resistance. In: Nunn’s applied respiratory physiology. 6th ed. Oxford: Butterworth-Heinemann; 2005.Google Scholar
- 26.Wilson WC, Shapiro B. Perioperative hypoxia: the clinical spectrum and current oxygen monitoring methodology. Anesthesiol Clin North Am. 2001;19:769–812.CrossRefGoogle Scholar
- 27.West JB. Respiratory physiology, the essentials. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.Google Scholar
- 28.Agrawal D, Feldman HA, Krauss B, Waltzman ML. Can bispectral index monitoring quantify depth of sedation during procedural sedation and analgesia in the pediatric emergency department? Ann Emerg Med. 2004;43:247–55.PubMedCrossRefGoogle Scholar
- 29.Gill M, Green SM, Krauss B. A study of the bispectral index monitor during procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2003;41:234–41.PubMedCrossRefGoogle Scholar
- 30.Miner JR, Biros M, Heegaard W, Plummer D. Bispectral EEG analysis of patients undergoing procedural sedation in the emergency department. Acad Emerg Med. 2003;10:638–43.PubMedGoogle Scholar
- 31.American Society of Anesthesiologists. Practice advisory for intraoperative awareness and brain function monitoring. Anesthesiology. 2006;104:847–64.CrossRefGoogle Scholar
- 32.Rosow C, Manberg PJ. Bispectral index monitoring. Anesthesiol Clin North Am. 2001;19:947–66.CrossRefGoogle Scholar
- 33.Malviya S, Voepel-Lewis T, Tait AR, Watcha MF, Sadhasivam S, Friesen RH. Effect of age and sedative agent on the accuracy of bispectral index in detecting depth of sedation in children. Pediatrics. 2007;120(3):e461–70.PubMedCrossRefGoogle Scholar
- 34.McDermott NB, VanSickle T, Motas D, Friesen RH. Validation of the bispectral index monitor during conscious and deep sedation in children. Anesth Analg. 2003;97(1):39–43.PubMedCrossRefGoogle Scholar
- 35.Hans P, Dewandre P-Y, Brichant JF, Bonhomme V. Comparative effects of ketamine on bispectral index and spectral entropy of the electroencephalogram under sevoflurane anaesthesia. Br J Anaesth. 2005;94(3):336–40.PubMedCrossRefGoogle Scholar
- 36.Overly FL, Wright RO, Connor FA, Fontaine B, Jay G, Linakis JG. Bispectral analysis during pediatric procedural sedation. Pediatr Emerg Care. 2005;21(1):6–11.PubMedCrossRefGoogle Scholar
- 37.Turkmen A, Altan A, Turgut N, Vatansever S, Gokkaya S. The correlation between the Richmond agitation-sedation scale and bispectral index during dexmedetomidine sedation. Eur J Anaesthesiol. 2006;23(4):300–4.PubMedCrossRefGoogle Scholar
- 38.Kasuya Y, Govinda R, Rauch S, Mascha EJ, Sessler DI, Turan A. The correlation between bispectral index and observational sedation scale in volunteers sedated with dexmedetomidine and propofol. Anesth Analg. 2009;109(6):1811–5.PubMedCrossRefGoogle Scholar
- 39.Rampil IJ. A primer for EEG signal processing in anesthesia. Anesthesiology. 1998;89(4):980–1002.PubMedCrossRefGoogle Scholar
- 40.Tortoriello TA, Stayer SA, Mott AR, et al. A noninvasive estimation of mixed venous oxygen saturation using near-infrared spectroscopy by cerebral oximetry in pediatric cardiac surgery patients. Paediatr Anaesth. 2005;15(6):495–503.PubMedCrossRefGoogle Scholar
- 41.Watzman HM, Kurth CD, Montenegro LM, Rome J, Steven JM, Nicolson SC. Arterial and venous contributions to near-infrared cerebral oximetry. Anesthesiology. 2000;93(4):947–53.PubMedCrossRefGoogle Scholar
- 42.Padmanabhan P, Berkenbosch JW, Lorenz D, Pierce MC. Evaluation of cerebral oxygenation during procedural sedation in children using near infrared spectroscopy. Ann Emerg Med. 2009;54(2):205–13.PubMedCrossRefGoogle Scholar
- 43.Carlin RE, McGraw DJ, Calimlim JR, Mascia MF. The use of near-infrared cerebral oximetry in awake carotid endarterectomy. J Clin Anesth. 1998;10(2):109–13.PubMedCrossRefGoogle Scholar
- 44.Absi MA, Lutterman J, Wetzel GT. Noninvasive cardiac output monitoring in the pediatric cardiac intensive care unit. Curr Opin Cardiol. 2010;25(2):77–9.PubMedCrossRefGoogle Scholar
- 45.Kubicek WG, Karnegis JN, Patterson RP, Witsoe DA, Mattson RH. Development and evaluation of an impedance cardiac output system. Aerosp Med. 1966;37(12):1208–12.PubMedGoogle Scholar
- 46.Schmidt C, Theilmeier G, Van Aken H, et al. Comparison of electrical velocimetry and transoesophageal Doppler echocardiography for measuring stroke volume and cardiac output. Br J Anaesth. 2005;95(5):603–10.PubMedCrossRefGoogle Scholar
- 47.Norozi K, Beck C, Osthaus WA, Wille I, Wessel A, Bertram H. Electrical velocimetry for measuring cardiac output in children with congenital heart disease. Br J Anaesth. 2008;100(1):88–94.PubMedCrossRefGoogle Scholar
- 48.Schubert S, Schmitz T, Weiss M, et al. Continuous, non-invasive techniques to determine cardiac output in children after cardiac surgery: evaluation of transesophageal Doppler and electric velocimetry. J Clin Monit Comput. 2008;22(4):299–307.PubMedCrossRefGoogle Scholar
- 49.Suttner S, Schöllhorn T, Boldt J, et al. Noninvasive assessment of cardiac output using thoracic electrical bioimpedance in hemodynamically stable and unstable patients after cardiac surgery: a comparison with pulmonary artery thermodilution. Intensive Care Med. 2006;32(12):2053–8.PubMedCrossRefGoogle Scholar
- 50.Green SM, Krauss B. The semantics of ketamine. Ann Emerg Med. 2000;36:480–2.PubMedGoogle Scholar
- 51.Green SM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation in children. Ann Emerg Med. 2004;44(5):460–71, Review.Google Scholar
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