Opioid Safety, Respiratory Compromise

Today’s Must-Have: Capnography Monitoring During Conscious Sedation

Today, the Physician-Patient Alliance for Health Safety released a clinical education podcast with Matt Kurrek, MD, FRCPC (Professor, Department of Anesthesia, University of Toronto) and Richard Merchant, MD, FRCPC (Clinical Professor, University of British Columbia, Department of Anesthesia, Pharmacology & Therapeutics).

Drs. Kurrek and Merchant coauthored an editorial, “Yesterday’s Luxury, Today’s Necessity” after the Canadian Anesthesiologists’ Society [CSA] published its revised 2012 guidelines to the practice of anesthesia. The CSA guidelines recommend capnography monitoring during conscious sedation. In the podcast, Drs. Kurrek and Merchant discuss why capnography monitoring may have been considered yesterday’s luxury, but is now a necessity during conscious sedation.

Yesterday’s Luxury, Today’s Must-Have: #Capnography Monitoring During Conscious Sedation #patientsafety Click To Tweet

CSA describes the term “conscious sedation” or “procedural sedation” as follows:

Sedation is “a state of reduced excitement or anxiety that is induced by the administration of a sedative agent”. This condition is distinct from “general anesthesia”, which is described as “a state of total unconsciousness resulting from anesthetic drug(s)” …

Dr. Merchant emphasized that capnography monitoring is “required” monitoring for general anesthesia and sedation (4-6 on the Ramsay Sedation Scale shown below):

We have to recognize that there is reasonable good evidence to support capnographic monitoring, respiratory monitoring, for deep sedated patients … Not surprisingly, evidence for lightly sedated patient is not a very strong … risk is probably related to the depth of sedation and includes by and large respiratory complications … to minimize those, the practitioner would be well advised to see what depths of sedation the patient would actually be best served for, given the patient’s co-mormidities, the resources, and the particular procedure.

The Ramsay Sedation Scale scores sedation at six different levels:

Dr. Kurrek discussed the lag in implementation of guidelines:

there still seems to be a considerable lag between the time of that editorial and the guidelines to monitor capnographically the respiratory status of the patient when deeply sedated.

Dr. Merchant said the costs of acquiring monitoring equipment is no longer an impediment:

Cost is no longer a prohibitive block, so there’s no reason that places should not consider using them.

Costs of acquiring #capnography is no longer an impediment - so, isn't it used more? #patientsafety Click To Tweet

To read a transcript of the interview, please click here.

The podcast may be viewed on the PPAHS YouTube channel by clicking here.

 

Leave a Reply

Your email address will not be published. Required fields are marked *