Document Detail

Carbon dioxide retention and oxygen desaturation during gastrointestinal endoscopy.
MedLine Citation:
PMID:  8335187     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Pulse oximetry measures arterial oxygen saturation (SpO2), not hypoventilation, which is directly reflected by increases in carbon dioxide tension. METHODS: In the present study, transcutaneous carbon dioxide tension (PtcCO2) and SpO2 were measured during 101 endoscopic procedures selected for long duration or comorbid illnesses, and relationships between hypercapnia and hypoxemia were evaluated. Nasal oxygen was administered only for sustained desaturation (SpO2 < 90%). RESULTS: Mean peak increase in PtcCO2 was significantly higher in patients requiring oxygen for sustained desaturation (16.3 mm Hg; range, 4-52) than in patients breathing room air who had transient or no desaturation (10.2 mm Hg [range, 3-19] and 5.1 mm Hg [range, 0-15]). If nasal oxygen corrected desaturation, even transient recurrence of desaturation indicated worsening CO2 retention, which preceded respiratory arrest in one patient. Independent predictors of hypercapnia were fentanyl and midazolam doses, oxygen requirement, and dementia. CONCLUSIONS: Severe hypoventilation may occur during endoscopy, undetected by clinical observation or pulse oximetry, but only in sedated patients who require supplemental oxygen to maintain SpO2 above 90%. After oxygen supplementation corrects desaturation, recurrence of desaturation implies severe hypoventilation and warrants limitation of further sedation.
M L Freeman; J T Hennessy; O W Cass; A M Pheley
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Gastroenterology     Volume:  105     ISSN:  0016-5085     ISO Abbreviation:  Gastroenterology     Publication Date:  1993 Aug 
Date Detail:
Created Date:  1993-08-26     Completed Date:  1993-08-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  331-9     Citation Subset:  AIM; IM    
Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis.
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MeSH Terms
Anoxia / etiology
Carbon Dioxide / metabolism*
Digestive System / metabolism*,  pathology*
Endoscopy* / adverse effects
Hypercapnia / etiology
Middle Aged
Oxygen / blood*
Skin / metabolism*
Reg. No./Substance:
124-38-9/Carbon Dioxide; 7782-44-7/Oxygen
Comment In:
Gastroenterology. 1994 Mar;106(3):820-1   [PMID:  8119558 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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