• S W Wright.
• Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
• Ann Emerg Med. 1992 May 1;21(5):551-5.

Study ObjectiveThe purpose of this observational study was to describe the use of nasal capnography and pulse oximetry in monitoring heavily sedated emergency department patients.DesignProspective, nonblinded, nonrandomized, noncontrolled clinical trial.SettingThe study was conducted in a tertiary-care hospital with 36,000 annual ED visits.Type Of ParticipantsTwenty-seven patients requiring sedation with benzodiazepines and/or narcotics for painful procedures.InterventionsThe ventilatory status of each patient was monitored with a capnometer by nasal cannula as well as a pulse oximeter before, during, and after administration of the sedative agents.MeasurementsVital signs, nasal end-tidal CO2 (PETCO2) measurements, and oxygen saturation were measured at baseline, during the procedure, and for a two-hour observation period after the procedure.Main ResultsThe average PETCO2 increased from 35.9 to 42.1 mm Hg during the procedure while the oxygen saturation dropped from an average of 98% to 94.3%. One patient developed clinically significant apnea after the procedure that was picked up by the apnea alarm, and eight additional patients developed clinically silent hypoxemia and increased PETCO2 during the procedure.ConclusionThe use of pulse oximetry is recommended for the detection of unrecognized hypoxemia during conscious sedation. Capnography by nasal cannula appears to be a useful modality in monitoring during conscious sedation, but further research and clinical experience are required before routine use can be recommended.

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