Managing the Risks of Procedural Sedation

While procedural sedation is usually safe, there can be associated risks.1  For example, respiratory depression is a serious risk that can lead to significant injury or even death. A patient may have apneas or an airway obstruction due to the level of sedation. Also, if a patient is over-sedated, it can lead to slower recovery time.

Supported by clinical papers, anesthesia societies and patient safety councils worldwide, a growing number of anesthesiologists and non-anesthesiologists responsible for providing moderate to deep sedation during procedural sedation are recognizing that using capnography monitoring can help enhance patient safety and improve outcomes.2-7

Patient Risk

When is Procedural Sedation Used and What Are the Risks?

Clinicians commonly administer procedural sedation to patients for procedures that do not require general anesthesia, but would likely be too uncomfortable for a patient to tolerate while in a conscious state. Some of the healthcare environments that use procedural sedation include:

  • Gastrointestinal Endoscopy (i.e. colonoscopy, ERCP)
  • Pulmonology (i.e. bronchoscopy)
  • Interventional Cardiology (i.e. cardiac catheterization)
  • Interventional Radiology (i.e. angioplasty)
  • Electrophysiology (i.e. cardiac mapping)
  • Emergency Department (i.e. intubation, alleviate pain and anxiety8)
  • Dental and Maxillofacial Surgery (i.e. tooth impactions)
  • Outpatient Surgery

Multiple factors can contribute to an increased risk of adverse events during procedural sedation including:

  • Patient's overall health and comorbidities
  • Age of patient and Body Mass Index9

Growing wave of capnography

A Tool for Managing the Risk of Respiratory Compromise

Over the last four years, 30 associations and clinical societies worldwide have identified capnography as a tool for managing the risk of respiratory compromise and issued statements and guidelines. Some of these societies have issued guidelines and statements specifically recommending the use of capnography during procedural sedation.

Clinical Evidence

Supporting Evidence for Procedural Sedation.

Capnography is a noninvasive, continuous measurement of carbon dioxide during the respiratory cycle as a function of time. It provides critical patient information:

  • An early indicator of hypoventilation, airway obstruction, no breathing
  • Helps clinicians manage potential risk of respiratory compromise as a consequence of over-sedation
  • Validates breathing and airway integrity (waveform shape)
  • Monitors respiration rate via pulmonary gas exchange

Numerous clinical studies have evaluated the utility of capnography monitoring to improve patient safety by alerting clinicians to indicators of respiratory depression and hypoxemia during procedural sedation.

Why Microstream™ Capnography?

View product recommendations for Microstream™ Capnography during procedural sedation.

  • 1.

  • 2. ECRI Institute. The Hazards of Alarm Overload: Keeping Excessive Physiologic Monitoring Alarms from Impeding Care. ECRI Guidance Article , March 2007.

  • 3. Qadeer MA, Vargo JJ, Dumot JA, et al. Capnographic monitoring of respiratory activity improves safety of sedation for endoscopic cholangiopancreatography and ultrasonography.Gastroenterology. 2009;136(5):1568-1576.

  • 4. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology.2002;96(4):1004-1017.

  • 5. ASA Standards, Guidelines, Statements. Statement on Granting Privileges for Administration of Moderate Sedation to Practitioners Who Are Not Anesthesia Professionals, (2011).

  • 6. Burton JH, Harrah JD, Germann CA, Dillon DC. Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices? Acad Emerg Med.2006;13(5):500-504.

  • 7. Lightdale JR, Goldmann DA, Feldman HA, Newburg AR, DiNardo JA, Fox VL. Microstream capnography improves patient monitoring during moderate sedation: a randomized, controlled trial.Pediatrics. 2006;117(6):e1170-1178.

  • 8. Goodwin, SA, Burton, JA, Gerardo, CJ et al. Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department. Annals of Emergency Medicine. February 2014;63:247-258.

  • 9. Karamnov, S, Sarkisian, N, Grammer, R, Gross, W, Urman, R. Analysis of Adverse Events Associated with Adult Moderate Procedural Sedation Outside the Operating Room. Journal of Patient Safety. September 8, 2014. doi: 10.1097/PTS.0000000000000135.