Situational Analysis

Deaths from patients receiving general anesthesia has, fortunately, declined from 1 per 5,500 to 1 per 20,000 (Institute of Medicine).

Unfortunately, this same improvement in patient safety has not been evidenced in children receiving moderate sedation without endotracheal intubation. As the introduction to the study published in the Pediatrics (the official journal of the American Academy of Pediatrics) points out:

Critical event analyses have documented that hypoxemia secondary to depressed respiratory activity is a principal risk factor for near misses and death in this population.

Conclusion

In looking at how best to monitor children undergoing elective gastrointestinal procedures with moderate sedation in a pediatric endoscopy unit, the Pediatrics study found:

The current standard of care for monitoring all patients receiving sedation relies overtly on pulse oximetry, which does not measure ventilation. Most medical societies and regulatory organizations consider moderate sedation to be safe but also acknowledge serious associated risks, including suboptimal ventilation, airway obstruction, apnea, hypoxemia, hypoxia, and cardiopulmonary arrest. The results of this controlled trial suggest that microstream capnography improves the current standard of care for monitoring sedated children by allowing early detection of respiratory compromise, prompting intervention to minimize hypoxemia.

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