| 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. | |
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MedLine Citation:
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PMID: 12024135 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Recommendations from the American Society of Anesthesiologists suggest that monitoring for apnea using the detection of exhaled carbon dioxide (capnography) is a useful adjunct in the assessment of ventilatory status of patients undergoing sedation and analgesia. There are no data on the utility of capnography in GI endoscopy, nor is the frequency of abnormal ventilatory activity during endoscopy known. The aims of this study were to determine the following: (1) the frequency of abnormal ventilatory activity during therapeutic upper endoscopy, (2) the sensitivity of observation and pulse oximetry in the detection of apnea or disordered respiration, and (3) whether capnography provides an improvement over accepted monitoring techniques. METHODS: Forty-nine patients undergoing therapeutic upper endoscopy were monitored with standard methods including pulse oximetry, automated blood pressure measurement, and visual assessment. In addition, graphic assessment of respiratory activity with sidestream capnography was performed in all patients. Endoscopy personnel were blinded to capnography data. Episodes of apnea or disordered respiration detected by capnography were documented and compared with the occurrence of hypoxemia, hypercapnea, hypotension, and the recognition of abnormal respiratory activity by endoscopy personnel. RESULTS: Comparison of simultaneous respiratory rate measurements obtained by capnography and by auscultation with a pretracheal stethoscope verified that capnography was an excellent indicator of respiratory rate when compared with the reference standard (auscultation) (r = 0.967, p < 0.001). Fifty-four episodes of apnea or disordered respiration occurred in 28 patients (mean duration 70.8 seconds). Only 50% of apnea or disordered respiration episodes were eventually detected by pulse oximetry. None were detected by visual assessment (p < 0.0010). CONCLUSIONS: Apnea/disordered respiration occurs commonly during therapeutic upper endoscopy and frequently precedes the development of hypoxemia. Potentially important abnormalities in respiratory activity are undetected with pulse oximetry and visual assessment. |
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Authors:
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John J Vargo; Gregory Zuccaro; John A Dumot; Darwin L Conwell; J Brad Morrow; Steven S Shay |
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Publication Detail:
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Type: Clinical Trial; Journal Article |
Journal Detail:
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Title: Gastrointestinal endoscopy Volume: 55 ISSN: 0016-5107 ISO Abbreviation: Gastrointest. Endosc. Publication Date: 2002 Jun |
Date Detail:
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Created Date: 2002-05-23 Completed Date: 2002-07-26 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0010505 Medline TA: Gastrointest Endosc Country: United States |
Other Details:
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Languages: eng Pagination: 826-31 Citation Subset: IM |
Affiliation:
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Center for Pancreaticobiliary Diseases, Department of Gastroenterology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Automatic Data Processing* Capnography* Computer Graphics* Endoscopy, Gastrointestinal / adverse effects* Female Gastrointestinal Diseases / surgery* Humans Image Processing, Computer-Assisted* Male Middle Aged Oximetry* Prospective Studies Respiratory Insufficiency / diagnosis*, etiology, physiopathology* Respiratory System / physiopathology* Sensitivity and Specificity Time Factors Visual Perception* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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