Oral 6: Capnographic Monitoring Does Not Improve Detection of Hypoxemia in Colonoscopy With Moderate Sedation A Randomized, Controlled Trial
Author insight from Paresh P. Mehta, MD, Cleveland Clinic, Cleveland, OH
What’s new here and important for clinicians?
This is the first randomized, controlled trial to evaluate if capnographic monitoring reduces the incidence of hypoxemia in healthy adults (ASAPS I or II) undergoing colonoscopy with moderate sedation. There was no difference in the incidence of hypoxemia between the two groups with open and blinded capnography alarm interventions (the primary outcome) and this is important to know prior to purchasing and training your endoscopy team to use these devices. However, there did appear to be a benefit in reducing rates of severe hypoxemia between the two groups although the study was not powered for these findings. We believe more evidence is needed to evaluate the use of capnography in both EGD and colonoscopy with moderate sedation prior to implementing its universal use.
What do patients need to know
Recent regulatory suggestions for the use of the most common sedation medications (which includes medications such as midazolam and fentanyl) in GI procedures such as upper endoscopy (or EGD) and colonoscopy have pushed for the use of a device that monitors exhaled carbon dioxide. This monitoring device is called capnography and has been shown to help detect early changes in breathing patterns with deeper sedation medications such as propofol or when patients needs to be placed under general anesthesia for surgery. Since sedation with upper and lower endoscopy with these common sedation medications (also known as moderate sedation) has been proven to be extremely safe with the current heart and breathing monitors that are used, the increased cost and specialized training needed for use of this device needs to be further studied.
All endoscopy centers strive for completing procedures in the safest possible way and this study was hoping to see if adding the device allows for earlier detection of changes in breathing patterns and oxygenation then we have now. We looked the ability of the device to detect lower oxygen rates in the body as the main study outcome and did not find an important difference between people who we monitored and had changes to their procedure or sedation based on the alarms from the capnography device. There were other changes that it did seem to help detect earlier including more significant changes in oxygen levels which occurred in a small portion of the study patients. We believe that more information is needed on both the monitoring device with other studies and on the select people who may be at risk for more significant oxygen changes during their procedure.
Paresh P. Mehta, MD, Cleveland Clinic, Cleveland, OH
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