Separate circuit nasal cannulae for end-tidal CO2 monitoring may lead to hypoxia in patients with unilateral nasal airway obstruction
Jared C. Cohen, Anthony M-H. Ho, Heather D. O’Reilly, Glenio B. Mizubuti
Abstract
Dear Editor,
Monitored anesthetic care in the form of moderate or deep sedation is ubiquitous in anesthesia practice. Given that most sedative agents affect respiration, hypopnea and apnea (secondary to airway obstruction and/or central nervous system depression) is of constant concern, as it may lead to significant hypoxia and potentially respiratory or cardiovascular collapse. In this setting, nasal cannulae are commonly used to provide low-flow supplemental oxygen to patients undergoing procedural sedation. The utilization of capnography monitoring has been shown to decrease the incidence of hypoxia compared to supplemental oxygen alone, likely due to earlier detection of ventilatory inadequacy allowing prompt intervention prior to the development of critical hypoxia. Therefore, capnography monitoring is deemed mandatory for all patients undergoing general anesthesia or procedural sedation by many renowned anesthesiology societies worldwide. Hence, nasal cannulae with combined side-stream sampling ports for waveform capnography monitoring are commonly used by anesthesiologists.
References
1. Askar H, Misch J, Chen Z, Chadha S, Wang HL. Capnography monitoring in procedural intravenous sedation: a systematic review and meta-analysis. Clin Oral Investig. 2020;24:3761−70.
2. Saunders R, Struys MMRF, Pollock RF, Mestek M, Lightdale JR. Patient safety during procedural sedation using capnography monitoring: a systematic review and meta-analysis. BMJ Open. 2017;7:e013402.
3. Dobson G, Chau A, Denomme J, et al. Guidelines to the Practice of Anesthesia: Revised Edition 2023. Can J Anaesth. 2023;70:16−55.
4. Klein AA, Meek T, Allcock E, et al. Recommendations for Standards of Monitoring During Anaesthesia and Recovery 2021. Anaesthesia. 2021;76:1212−23.
5. Hinkelbein J, Lamperti M, Akeson J, et al. European Society of Anaesthesiology and European Board of Anaesthesiology Guidelines for Procedural Sedation and Analgesia in Adults. Eur J Anaesthesiol. 2018;35:6−24.
6. Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018. A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Anesthesiology. 2018;128:437−79.
7. Villwock JA, Kuppersmith RB. Diagnostic algorithm for evaluating nasal airway Obstruction. Otolaryng Clin North Am. 2018;51: 867−72.
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