Annals of Emergency Medicine
Volume 55, Issue 3 , Pages 258-264 , March 2010

Does End Tidal CO2 Monitoring During Emergency Department Procedural Sedation and Analgesia With Propofol Decrease the Incidence of Hypoxic Events? A Randomized, Controlled Trial

  • Kenneth Deitch, DO

      Affiliations

    • Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA
    • Corresponding Author InformationAddress for reprints: Ken Deitch, DO, Department of Emergency Medicine, Albert Einstein Medical Center, 5501 Old York Road, Korman Building, B-6, Philadelphia, PA 19141; 215-456-6679
    • ,
  • Jim Miner, MD

      Affiliations

    • Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
    • ,
  • Carl R. Chudnofsky, MD

      Affiliations

    • Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA
    • ,
  • Paul Dominici, MD

      Affiliations

    • Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA
    • ,
  • Daniel Latta, BS

      Affiliations

    • Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA

Received 24 April 2009 ,Revised 8 July 2009 ,Accepted 22 July 2009.

References 

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  2. American Society of Anesthesiology. Standards for basic anesthetic monitoring. Approved October 21, 1986 and last amended October 25, 2005.
  3. American College of Emergency Physicians. Clinical policy for procedural sedation and analgesia in the emergency department. Ann Emerg Med. 1998;31:663–677
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  7. Miner JR, Biros MH, Heegaard W, et al. Bispectral electroencephalographic analysis of patients undergoing procedural sedation in the emergency department. Acad Emerg Med. 2003;10:638
  8. Deitch K, Chudnofsky CR, Dominici P. The utility of supplemental oxygen during emergency department procedural sedation and analgesia with propofol: a randomized, controlled trial. Ann Emerg Med. 2008;52:1–8
  9. Lightdale JR, Goldmann DA, Feldman HA, et al. Microstream capnography improves patient monitoring during moderate sedation: a randomized controlled trial. Pediatrics. 2006;117:e1170–e1178
  10. Burton JH, Harrah JD, Germann CA, et al. Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices?. Acad Emerg Med. 2006;13:500–504
  11. Havel CJ, Strait R, Hennes H. A clinical trial of propofol vs. midazolam for procedural sedation in a pediatric emergency department. Acad Emerg Med. 1999;6:989–997
  12. Symington L, Thakore S. A review of the use of propofol for procedural sedation in the emergency department. Emerg Med J. 2006;23:89–93
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  16. Godambe SA, Elliot V, Matheny D, et al. Comparison of propofol/fentanyl versus ketamine/midazolam for brief orthopaedic procedural sedation in a pediatric emergency department. Pediatrics. 2003;112:116–123
  17. Miner JR, Biros MH, Krieg S, et al. Randomized clinical trial of propofol versus methohexital for procedural sedation during fracture and dislocation reduction in the emergency department. Acad Emerg Med. 2003;10:931
  18. Wright SW. Conscious sedation in the emergency department: the value of capnography and pulse oximetry. Ann Emerg Med. 1992;21:551
  19. Hart LS, Berns SD, Houck CS, et al. The value of end-tidal CO2 monitoring when comparing three methods of conscious sedation for children undergoing painful procedures in the emergency department. Pediatr Emerg Care. 1997;13:189–193
  20. Miner JR, Heegaard W, Plummer D. End-tidal carbon dioxide monitoring during procedural sedation. Acad Emerg Med. 2002;9:275
  21. Anderson JL, Junkid E, Pribble C, et al. Capnography and depth of sedation during propofol sedation in children. Ann Emerg Med. 2007;49:9–13
  22. Deitch K, Chudnofsky CR, Dominici P. The utility of supplemental oxygen during emergency department procedural sedation and analgesia with midazolam and fentanyl: a randomized, controlled trial. Ann Emerg Med. 2007;49:1–8

 Supervising editor: Steven M. Green, MD

 Author contributions: KD, JM, and CRC conceived the study and designed the trial. KD, CRC, and PD supervised the conduct of the trial and data collection. KD, CRC, and PD managed the data, including quality control. PD and DL provided statistical advice on study design and analyzed the data. KD drafted the article. CRC and JM provided editorial support and contributed substantially to its revisions. KD takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.The Capnostream 20 was donated for research purposes by Oridian Medical, Needham, MA.

 Earn CME Credit: Continuing Medical Education is available for this article at: http://www.ACEP-EmedHome.com.

 Provide feedback on this article at the journal's Web site, www.annemergmed.com.

 Please see page 259 for the Editor's Capsule Summary of this article.

 Publication date: Available online September 24, 2009.

PII: S0196-0644(09)01429-2

doi: 10.1016/j.annemergmed.2009.07.030

Annals of Emergency Medicine
Volume 55, Issue 3 , Pages 258-264 , March 2010

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