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Category: Volume 12 Issue 02 February 2024
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Title: Observational Cross-Sectional Study of ETCO2 and Pulse Oximetry for Early Detection of Hypoxia in MAC Patient (Monitored Anaesthesia Care)

Authors: Dr Rajshree, Dr Vaijayanti Gadre, Dr Bhairavi Tawde

 DOI: https://dx.doi.org/10.18535/jmscr/v12i02.09

Abstract

Background and Aim:  The study aims to identify whether ETCO2 detects early hypoxia compared to monitoring of SpO2, HR and RR (Standard Monitor) in patients undergoing surgical procedure under MAC.

Method: Total 336 patients belonging to Age group of 18-60 years, ASA grade 1 and grade 2, procedure lasting for <4hrs, undergoing sedation under MAC for day care surgery. Measurements of Spo2, HR, RR, ETCO2, NIBP done by applying monitors. Nasal cannula also put for supplemental Oxygen.

Result: Overall 92 episodes of disordered ventilation were detected out of which 67 were detected by ETCO2 (44- Hypoventilation and 23- Apnoea) and 25 were detected by Pulse Oximetry (4- Hypoventilation and 21- desaturation. Overall a mean delay of 51.04 seconds was seen in detection by Pulse Oximetry.

Conclusion: In the study it was concluded that patients under sedation, underwent frequent episodes of disordered ventilation leading to hypoxia. In such scenarios it was seen that ETCO2 monitoring provided a practical advantage of detecting hypoventilation and apnea earlier than Pulse Oximetry showing desaturation.

Keywords: Capnography, ETCO2, pulse oximetry.

References

  1. Das S, Ghosh S. Monitored anesthesia care: An overview. J Anaesthesiol Clin Pharmacol. 2015;31(1):27-29. doi:10.4103/0970-9185.150525.
  2. Siddiqui BA, Kim PY. Anesthesia Stages. [Updated 2020 Apr 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557596/.
  3. Holton, Jace; Flattery, Bryan, JBI Database of Systematic Reviews and Implementation Reports: December 2016 - Volume 14 - Issue 12 - p 38-47.
  4. Heuss LT, Sugandha SP, Beglinger C. Carbon dioxide accumulation during analgosedated colonoscopy: comparison of propofol and midazolam. World J Gastroenterol. 2012 Oct 14;18(38):5389-96. doi: 10.3748/wjg.v18.i38.5389. PMID: 23082055; PMCID: PMC3471107.
  5. Lam T, Nagappa M, Wong J, Singh M, Wong D, Chung F. Continuous Pulse Oximetry and Capnography Monitoring for Postoperative Respiratory Depression and Adverse Events: A Systematic Review and Meta-analysis. AnesthAnalg. 2017 Dec;125(6):2019-2029. doi: 10.1213/ANE.0000000000002557. PMID: 29064874.
  6. Khanna AK, Bergese SD, Jungquist CR, Morimatsu H, Uezono S, Lee S, Ti LK, Urman RD, McInty; PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) Group Collaborators. Prediction of Opioid-Induced Respiratory Depression on Inpatient Wards Using Continuous Capnography and Oximetry: An International Prospective, Observational Trial. AnesthAnalg. 2020 Oct;131(4):1012-1024. doi: 10.1213/ANE.0000000000004788. PMID: 32925318; PMCID: PMC7467153.
  7. Iwasaki J, Vann WF Jr, Dilley DC, Anderson JA. An investigation of capnography and pulse oximetry as monitors of pediatric patients sedated for dental treatment. Pediatr Dent. 1989 Jun;11(2):111-7. PMID: 2503818.
  8. Cacho G, Pérez-Calle JL, Barbado A, Lledó JL, Ojea R, Fernández-Rodríguez CM. Capnography is superior to pulse oximetry for the detection of respiratory depression during colonoscopy. Rev EspEnferm Dig. 2010 Feb;102(2):86-9. doi: 10.4321/s1130-01082010000200003. PMID: 20361844.
  9. TY - JOUR AU - Khalil, Nahla AU - Fathallah, Marwa PY - 2019/05/11 SP - 1 EP - 6 T1 - Comparison of Pulse Oximetry and Capnography Monitoring with Arterial Blood Gases Parameters among Postoperative Pediatric Cardiac Surgeries at a University Hospital VL - 1 DO - 10.33552/IJNC.2019.01.000520 JO - Iris Journal of Nursing & Care ER - .
  10. Bergese SD, Mestek ML, Kelley SD, McIntyre R Jr, Uribe AA, Sethi R, Watson JN, Addison PS. Multicenter Study Validating Accuracy of a Continuous Respiratory Rate Measurement Derived From Pulse Oximetry: A Comparison With Capnography. AnesthAnalg. 2017 Apr;124(4):1153-1159. doi: 10.1213/ANE.0000000000001852. PMID: 28099286; PMCID: PMC5367492.
  11. Vargo JJ, Zuccaro G Jr, Dumot JA, Conwell DL, Morrow JB, Shay SS. Automated graphic assessment of respiratory activity is superior to pulse oximetry and visual assessment for the detection of early respiratory depression during therapeutic upper endoscopy. GastrointestEndosc. 2002 Jun;55(7):826-31. doi: 10.1067/mge.2002.124208. PMID: 12024135.
  12. Langhan ML, Ching K, Northrup V, Alletag M, Kadia P, Santucci K, Chen L. A randomized controlled trial of capnography in the correction of simulated endotracheal tube dislodgement. AcadEmerg Med. 2011 Jun;18(6):590-6. doi: 10.1111/j.1553-2712.2011.01090.x. PMID: 21676056; PMCID: PMC3117244.
  13. Williams GW 2nd, George CA, Harvey BC, Freeman A Comparison of Measurements of Change in Respiratory Status in Spontaneously Breathing Volunteers by the ExSpironNoninvasive Respiratory Volume Monitor Versus the Capnostream Capnometer. AnesthAnalg. 2017 Jan;124(1):120-126. doi: 10.1213/ANE.0000000000001395. PMID: 2738498.

Corresponding Author

Dr Rajshree

Anaesthetist at LTMG Sion hospital

Grant Government Medical College and Sir JJ Group of Hospitals

J J Marg, Nagpada, Mumbai Central, Mumbai, Maharashtra 400008