Situation

According to the Society for Pediatric Anesthesia, many different types of procedures may require a patient who is a child to stay still or may cause them discomfort if no anesthesia is used. For example, procedures such as MRI scans require the child to be completely still to ensure adequate quality of the scans.

However, hypopneic hypoventilation, a decrease in tidal volume without a change in respiratory rate, is not easily detected by standard monitoring practices during sedation.

Consequently, the safety of children could be at risk when they undergo common procedures involving sedation, such as for fracture reduction, laceration repair, and incision and drainage of an abscess.  A breakdown of the study subjects is provided below:

Solution

As a recent study published in Pediatric Emergency Care found, 72% of the episodes of prolonged hypoxia were preceded by decreases in ETco2 as measured by capnography. This suggests that the use of capnography would enhance patient safety by decreasing the frequency of hypoxia during sedation in children.

This study was conducted by Drs. Melissa Langhan, Lei Chen, Clement Marshall, and Karen Santucci, at Section of Emergency Medicine, Department of Pediatrics, Yale University School of Medicine.

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