Among healthy patients undergoing routine esophagogastroduodenoscopy or colonoscopy with moderate sedation, capnographic monitoring did not reduce the incidence of hypoxemia in a recent trial.
“The American Society of Anesthesiologists and other regulatory bodies had recommended that capnography be utilized for endoscopic procedures targeting moderate sedation,” John J. Vargo, MD, MPH, from the Digestive Disease Institute at the Cleveland Clinic in Ohio, told Healio Gastroenterology. “We found that there was no data to support that recommendation and that it was coming from expert opinion. So we decided to embark on this study to try to determine if there was a safety advantage to utilizing capnography in these patients.”
John J. Vargo
Vargo and colleagues performed a randomized, parallel group trial involving 452 healthy patients with ASA Physical Classifications I and II who were scheduled for routine outpatient esophagogastroduodenoscopy (EGD; n = 218; 35.9% male; mean BMI, 27.9 kg/m2) or colonoscopy (n = 234; 49.4% male; mean BMI, 29.1 kg/m2) with moderate sedation using an opioid and benzodiazepine. Patients were randomly assigned to have their procedure done with the endoscopy team either being aware of or blinded to the capnography results.
Hypoxemia incidence defined as a fall in oxygen saturation to less than 90% for at least 10 seconds served as the primary endpoint.
“We found for both the upper endoscopy and colonoscopy arms of the trial, there was no difference in the incidence of hypoxemia with or without capnography,” Vargo said.
Hypoxemia rates were 54.1% and 49.5% in the blinded and open capnography EGD groups, respectively (P = .05), and 53.8% vs. 52.1% for the blinded and open capnography colonoscopy groups, respectively (P = .79).
“This study very much clarifies the use of capnography in this patient subset, and that capnography does not appear to have a safety advantage,” Vargo said. “We look to have our findings validated by other groups, but this tells us that in healthy patients undergoing upper endoscopy or colonoscopy targeting moderate sedation with an opioid and benzodiazepine, capnography did not lead to an improvement in safety.” - by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.