Original ArticlesAutomated graphic assessment of respiratory activity is superior to pulse oximetry and visual assessment for the detection of early respiratory depression during therapeutic upper endoscopy☆
Section snippets
Patient selection
Patients undergoing elective complex upper endoscopic procedures, defined as ERCP, upper endoscopy with expandable metal stent placement, photodynamic therapy, EUS, and therapeutic push enteroscopy were considered candidates for inclusion. These procedures were chosen because they commonly are prolonged (>30 minutes) and frequently require administration of multiple doses of agents traditionally used for sedation and analgesia. Exclusion criteria were as follows: age less than 18 years,
Results
Forty-nine patients (28 men, 21 women; mean age 57.1 years, range 28-88 years) participated in the study (Table 1); 57% were ASA class I or II.Comorbid illnesses included liver disease (22.4%), chronic obstructive pulmonary disease (16%), ischemic heart disease (14.3%), and renal insufficiency (2%). Tobacco or ethanol were currently being used by, respectively, 51% and 6% of the patients. Medication use included narcotics (33%), benzodiazepines (12%), and other sedatives or psychotropic agents
Discussion
The current study is the first prospective evaluation of the utility of capnography in providing a real time, breath to breath, graphic assessment of respiratory activity during therapeutic upper endoscopy. The extended monitoring provided by capnography resulted in an accurate assessment of respiratory rate when compared to auscultation with a pretracheal stethoscope as the reference standard. Apnea and disordered respiration occurred in over 50% of patients and frequently preceded the
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Reprint requests: John J. Vargo, MD, Department of Gastroenterology, Desk A-30, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195.