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Published in: BMC Pulmonary Medicine 1/2017

Open Access 01-12-2017 | Research article

End-tidal capnographic monitoring to detect apnea episodes during flexible bronchoscopy under sedation

Authors: Tsukasa Ishiwata, Kenji Tsushima, Mai Fujie, Kenichi Suzuki, Kosuke Hirota, Mitsuhiro Abe, Naoko Kawata, Jiro Terada, Koichiro Tatsumi

Published in: BMC Pulmonary Medicine | Issue 1/2017

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Abstract

Background

Apnea developing as a result of oversedation is a potential clinical problem in patients undergoing flexible bronchoscopy (FB) under sedation. However, there are no reports of evaluation using a standardized method of the frequency of occurrence of apnea episodes during FB under sedation. The aim of this study was to investigate the frequency of apnea episodes during FB under sedation in the clinical setting by end-tidal capnography.

Methods

This study was a single-institution retrospective review of a prospectively maintained database and medical records, including capnographic data, from April 2015 to March 2016. We enrolled patients who were sedated with midazolam and underwent diagnostic FB under end-tidal capnographic monitoring. Apnea was defined as cessation of airflow for more than 10 s.

Results

Data from a total of 121 eligible patients were analyzed. A total of 131 apnea episodes (median duration 33 s) were recorded in 59 patients (48.8%). Prolonged apnea episodes lasting for more than 30 s occurred in 24 patients (19.8%). Furthermore, 55 apnea episodes (42.0%) were followed by a decline of the SpO2 by ≥4% from the baseline.

Conclusions

In this study, end-tidal capnography revealed the occurrence of apnea episodes at a high frequency in patients undergoing FB under sedation in the clinical setting.
Literature
1.
go back to reference The American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96(4):1004–17.CrossRef The American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96(4):1004–17.CrossRef
2.
go back to reference Forster A, Gardaz JP, Suter PM, Gemperle M. Respiratory depression by midazolam and diazepam. Anesthesiology. 1980;53(6):494–7.CrossRefPubMed Forster A, Gardaz JP, Suter PM, Gemperle M. Respiratory depression by midazolam and diazepam. Anesthesiology. 1980;53(6):494–7.CrossRefPubMed
3.
go back to reference Abdelmalak BB, Wang J, Mehta AC. Capnography monitoring in procedural sedation for bronchoscopy. J Bronchology Interv Pulmonol. 2014;21(4):370–1.CrossRefPubMed Abdelmalak BB, Wang J, Mehta AC. Capnography monitoring in procedural sedation for bronchoscopy. J Bronchology Interv Pulmonol. 2014;21(4):370–1.CrossRefPubMed
5.
go back to reference Cacho G, Perez-Calle JL, Barbado A, Lledo JL, Ojea R, Fernandez-Rodriguez CM. Capnography is superior to pulse oximetry for the detection of respiratory depression during colonoscopy. Rev Esp Enferm Dig. 2010;102(2):86–9.CrossRefPubMed Cacho G, Perez-Calle JL, Barbado A, Lledo JL, Ojea R, Fernandez-Rodriguez CM. Capnography is superior to pulse oximetry for the detection of respiratory depression during colonoscopy. Rev Esp Enferm Dig. 2010;102(2):86–9.CrossRefPubMed
6.
go back to reference Gaisl T, Bratton DJ, Heuss LT, Kohler M, Schlatzer C, Zalunardo MP, Frey M, Franzen D. Sedation during bronchoscopy: data from a nationwide sedation and monitoring survey. BMC Pulm Med. 2016;16(1):113.CrossRefPubMedPubMedCentral Gaisl T, Bratton DJ, Heuss LT, Kohler M, Schlatzer C, Zalunardo MP, Frey M, Franzen D. Sedation during bronchoscopy: data from a nationwide sedation and monitoring survey. BMC Pulm Med. 2016;16(1):113.CrossRefPubMedPubMedCentral
7.
go back to reference Netzer N, Eliasson AH, Netzer C, Kristo DA. Overnight pulse oximetry for sleep-disordered breathing in adults: a review. Chest. 2001;120(2):625–33.CrossRefPubMed Netzer N, Eliasson AH, Netzer C, Kristo DA. Overnight pulse oximetry for sleep-disordered breathing in adults: a review. Chest. 2001;120(2):625–33.CrossRefPubMed
8.
go back to reference Vargo JJ, Zuccaro Jr G, 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. Gastrointest Endosc. 2002;55(7):826–31.CrossRefPubMed Vargo JJ, Zuccaro Jr G, 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. Gastrointest Endosc. 2002;55(7):826–31.CrossRefPubMed
9.
go back to reference Fu ES, Downs JB, Schweiger JW, Miguel RV, Smith RA. Supplemental oxygen impairs detection of hypoventilation by pulse oximetry. Chest. 2004;126(5):1552–8.CrossRefPubMed Fu ES, Downs JB, Schweiger JW, Miguel RV, Smith RA. Supplemental oxygen impairs detection of hypoventilation by pulse oximetry. Chest. 2004;126(5):1552–8.CrossRefPubMed
10.
go back to reference Keidan I, Gravenstein D, Berkenstadt H, Ziv A, Shavit I, Sidi A. Supplemental oxygen compromises the use of pulse oximetry for detection of apnea and hypoventilation during sedation in simulated pediatric patients. Pediatrics. 2008;122(2):293–8.CrossRefPubMed Keidan I, Gravenstein D, Berkenstadt H, Ziv A, Shavit I, Sidi A. Supplemental oxygen compromises the use of pulse oximetry for detection of apnea and hypoventilation during sedation in simulated pediatric patients. Pediatrics. 2008;122(2):293–8.CrossRefPubMed
11.
go back to reference Koniaris LG, Wilson S, Drugas G, Simmons W. Capnographic monitoring of ventilatory status during moderate (conscious) sedation. Surg Endosc. 2003;17(8):1261–5.CrossRefPubMed Koniaris LG, Wilson S, Drugas G, Simmons W. Capnographic monitoring of ventilatory status during moderate (conscious) sedation. Surg Endosc. 2003;17(8):1261–5.CrossRefPubMed
12.
go back to reference Beitz A, Riphaus A, Meining A, Kronshage T, Geist C, Wagenpfeil S, Weber A, Jung A, Bajbouj M, Pox C, Schneider G, Schmid RM, Wehrmann T, von Delius S. Capnographic monitoring reduces the incidence of arterial oxygen desaturation and hypoxemia during propofol sedation for colonoscopy: a randomized, controlled study (ColoCap Study). Am J Gastroenterol. 2012;107(8):1205–12.CrossRefPubMed Beitz A, Riphaus A, Meining A, Kronshage T, Geist C, Wagenpfeil S, Weber A, Jung A, Bajbouj M, Pox C, Schneider G, Schmid RM, Wehrmann T, von Delius S. Capnographic monitoring reduces the incidence of arterial oxygen desaturation and hypoxemia during propofol sedation for colonoscopy: a randomized, controlled study (ColoCap Study). Am J Gastroenterol. 2012;107(8):1205–12.CrossRefPubMed
13.
go back to reference Qadeer MA, Vargo JJ, Dumot JA, Lopez R, Trolli PA, Stevens T, Parsi MA, Sanaka MR, Zuccaro G. Capnographic monitoring of respiratory activity improves safety of sedation for endoscopic cholangiopancreatography and ultrasonography. Gastroenterology. 2009;136(5):1568–76.CrossRefPubMed Qadeer MA, Vargo JJ, Dumot JA, Lopez R, Trolli PA, Stevens T, Parsi MA, Sanaka MR, Zuccaro G. Capnographic monitoring of respiratory activity improves safety of sedation for endoscopic cholangiopancreatography and ultrasonography. Gastroenterology. 2009;136(5):1568–76.CrossRefPubMed
14.
go back to reference Gaucher A, Frasca D, Mimoz O, Debaene B. Accuracy of respiratory rate monitoring by capnometry using the Capnomask(R) in extubated patients receiving supplemental oxygen after surgery. Br J Anaesth. 2012;108:316–20.CrossRefPubMed Gaucher A, Frasca D, Mimoz O, Debaene B. Accuracy of respiratory rate monitoring by capnometry using the Capnomask(R) in extubated patients receiving supplemental oxygen after surgery. Br J Anaesth. 2012;108:316–20.CrossRefPubMed
15.
go back to reference Mimoz O, Benard T, Gaucher A, Frasca D, Debaene B. Accuracy of respiratory rate monitoring using a non-invasive acoustic method after general anaesthesia. Br J Anaesth. 2012;108:872–5.CrossRefPubMed Mimoz O, Benard T, Gaucher A, Frasca D, Debaene B. Accuracy of respiratory rate monitoring using a non-invasive acoustic method after general anaesthesia. Br J Anaesth. 2012;108:872–5.CrossRefPubMed
16.
go back to reference Ramsay MA, Usman M, Lagow E, Mendoza M, Untalan E, De Vol E. The accuracy, precision and reliability of measuring ventilatory rate and detecting ventilatory pause by rainbow acoustic monitoring and capnometry. Anesth Analg. 2013;117:69–75.CrossRefPubMed Ramsay MA, Usman M, Lagow E, Mendoza M, Untalan E, De Vol E. The accuracy, precision and reliability of measuring ventilatory rate and detecting ventilatory pause by rainbow acoustic monitoring and capnometry. Anesth Analg. 2013;117:69–75.CrossRefPubMed
17.
go back to reference Wilkinson JN, Thanawala VU. Thoracic impedance monitoring of respiratory rate during sedation--is it safe? Anaesthesia. 2009;64:455–6.CrossRefPubMed Wilkinson JN, Thanawala VU. Thoracic impedance monitoring of respiratory rate during sedation--is it safe? Anaesthesia. 2009;64:455–6.CrossRefPubMed
18.
go back to reference Chhajed PN, Rajasekaran R, Kaegi B, Chhajed TP, Pflimlin E, Leuppi J, Tamm M. Measurement of combined oximetry and cutaneous capnography during flexible bronchoscopy. Eur Respir J. 2006;28:386–90.CrossRefPubMed Chhajed PN, Rajasekaran R, Kaegi B, Chhajed TP, Pflimlin E, Leuppi J, Tamm M. Measurement of combined oximetry and cutaneous capnography during flexible bronchoscopy. Eur Respir J. 2006;28:386–90.CrossRefPubMed
19.
go back to reference Dreher M, Ekkernkamp E, Storre JH, Kabitz HJ, Windisch W. Sedation during flexible bronchoscopy in patients with pre-existing respiratory failure: Midazolam versus Midazolam plus Alfentanil. Respiration. 2010;79(4):307–14.CrossRefPubMed Dreher M, Ekkernkamp E, Storre JH, Kabitz HJ, Windisch W. Sedation during flexible bronchoscopy in patients with pre-existing respiratory failure: Midazolam versus Midazolam plus Alfentanil. Respiration. 2010;79(4):307–14.CrossRefPubMed
Metadata
Title
End-tidal capnographic monitoring to detect apnea episodes during flexible bronchoscopy under sedation
Authors
Tsukasa Ishiwata
Kenji Tsushima
Mai Fujie
Kenichi Suzuki
Kosuke Hirota
Mitsuhiro Abe
Naoko Kawata
Jiro Terada
Koichiro Tatsumi
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2017
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/s12890-016-0361-7

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