Capnography and Depth of Sedation During Propofol Sedation in Children
Presented at the Pediatric Academic Society annual meeting, May 2005, Washington, DC.
Received 28 September 2005; received in revised form 17 May 2006 and 26 May 2006; accepted 8 June 2006. published online 18 August 2006.
Refers to article:
Research Advances in Procedural Sedation and Analgesia
, 06 November 2006
Steven M. Green
Annals of Emergency Medicine
January 2007 (Vol. 49, Issue 1, Pages 31-36) Full Text |
Full-Text PDF (100 KB)
Study objective
To evaluate the relationship between continuous capnography and observed airway and respiratory adverse effects and the depth of sedation when using propofol for pediatric orthopedic procedures.
Methods
We administered propofol after opioid premedication in a prospective convenience sample of children undergoing orthopedic reduction in our emergency department (ED). All children received supplemental oxygen (1 L/minute by nasal cannula) and continuous capnography and had depth of sedation assessed every 2 minutes. Adverse airway or respiratory events and any associated interventions were recorded.
Results
Adverse airway or respiratory events with intervention occurred in 14 of the 125 enrolled children (11%; 95% confidence interval 4.0% to 14%): jaw thrust in 4, supplemental oxygen in 6, and bag-valve-mask ventilation in 4. All interventions required were brief (<30 seconds). Capnography detected apnea before clinical examination or pulse oximetry in all 5 occurrences and similarly first detected airway obstruction in 6 of the 10 occurrences. The median maximal modified Ramsay score was 6 (range 3 to 8), ie, deep sedation.
Conclusion
When propofol is administered for ED deep sedation to facilitate pediatric orthopedic reduction, continuous capnography detects most airway and respiratory events leading to intervention before clinical examination or pulse oximetry.
aDivision of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT
bDivision of Pediatric Anesthesia and Critical Care, University of Utah, Salt Lake City, UT
Address for correspondence: Jana L. Anderson, MD, PO Box 581289, Salt Lake City, UT 84158; fax 801-587-7455
Supervising editor: Steven M. Green, MD
Author contributions: JLA, CP, and EG conceived the study and designed the trial. JLA obtained the research funding. JLA and EG supervised the conduct of the trial and data collection. JLA and EG undertook recruitment of patients and managed the data, including quality control. EJ and EG provided statistical advice on study design. JLA and EJ analyzed the data. JLA drafted the manuscript, and all authors contributed substantially to its revision. JLA takes responsibility for the paper as a whole.
Funding and support: This study was funded by a Foundation Clinical Research Grant at Primary Children’s Medical Center, Salt Lake City, UT.
ABSTRACT