Sedation Capnography

Sedation Capnography

By M. Ron Eslinger, RN, CRNA, APN, MA, BCH, FNCH

Capnography can be an interval part of the monitoring done in moderate and procedural sedation.
The 2010 House of Delegates of the American Society of Anesthesiologists (ASA) a mended it standards for basic anesthetic monitoring to include mandatory exhaled end-title carbon dioxide(EtCO)monitoring during both moderate and deep sedation to existing requirements for endotracheal and laryngeal mask airway general anesthesia. It became effective as of July 2011 and now reads:

“The American society of anesthesiologists states that: getting moderate and deep sedation, adequacy of ventilation shall be evaluated by continual observation of qualitative clinical signs and monitoring for the presence of XL carbon dioxide unless precluded or invalidated by the nature of the patient, procedure or equipment”

The learner watching this video will be able to:
• define the components of CO2 monitoring
• discussed the pros and cons of Capnography
• review the respiratory cycle
• compare Capnography to oximetry
• identify parts of the Capnography waveform


Evidence has shown that there is increased safety when capnography is used during nurse moderate sedation.



Objectives
The learner will be able to:

• Define the components of CO2 monitoring.
• Discuss Pros and Cons of Capnography.
• Review respiratory cycle.
• Compare Capnography to Oximetry.
• Identify Parts of the Wave Form.


Capnography

• Can be an integral part of the monitoring done in moderate and procedural sedation.
• Is used to monitor / measure the amount of carbon dioxide in respiratory gases.
• Provides information about the effectiveness of respiration’s and end-tidal carbon dioxide values.


Capnography vs Oximetry

• Capnography monitors ventilation, while pulse oximetry monitors oxygenation.
• Capnography thus provides breath-to-breath feedback, and changes in breathing, like apnea, are reflected immediately.
• Changes in pulse oximetry can lag behind breathing changes.


Basic Physiology

• Carbon dioxide is produced in the tissues by metabolism and is then diffused into the blood via the venous system (this is basically equal to cardiac output)
• The blood carrying carbon dioxide enters the right side of the heart and from there travels to the lungs.
• This is where oxygen enters the blood.



Increased Safety of Nurse Sedation

• Acute respiratory events or respiratory depression were earlier identified due to the monitoring of the waveforms on the capnography monitor.
• Capnography can also help detect alveolar hypoventilation even in the presence of supplemental oxygen.
• The use of capnography can reduce hypoxemia and lead to better outcomes in patients undergoing moderate sedation.