Utility of endtidal carbon dioxide monitoring in detection of hypoxia during sedation for brain magnetic resonance imaging in children with developmental disabilities

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Abstract

Background: We have shown previously that children with developmental disabilities have three times higher incidence of sedation-related hypoxia when compared with normal children. Objectives: Our objectives were to describe the changes in endtidal carbon dioxide (ETCO 2) values and the utility of ETCO 2 monitoring in earlier identification of hypoxia during sedation for brain magnetic resonance imaging (MRI) in children with developmental disabilities. Methods: We conducted a prospective observational study of a convenience sample of 150 children with developmental disabilities aged 1-10 years who received intravenous sedation for brain MRI. Children were sedated and monitored according to the institution's sedation protocol. We recorded ETCO 2 levels, hypoxia, and adverse events during sedation. Hypoxia was defined as SpO 2 < 93%. A change in ETCO 2 level ≥ 10 mm Hg from presedation baseline, an intra-sedation ≥ 50 mm Hg, and loss of capnographic waveform were considered as significant ETCO 2 abnormalities. Results: Of the children, 80.7% (121/150) were sedated with a combination of pentobarbital and fentanyl. ETCO 2 abnormalities were noted in 42.6% (64/150) of sedation encounters. Hypoxia occurred in 18% (27/150) of subjects. ETCO 2 abnormalities were documented in 19(70%) patients with hypoxia before changes in pulse oximetry were noted. ETCO 2 changes were noted a mean of 4.38 ± 1.89 min prior to occurrence of hypoxia. Conclusions: ETCO 2 abnormalities and hypoxia occur commonly during sedation in children with developmental disabilities. ETCO 2 monitoring is useful in early recognition of impending hypoxia during sedation in children with developmental disabilities.

Original languageEnglish
Pages (from-to)1241-1246
Number of pages6
JournalPaediatric Anaesthesia
Volume21
Issue number12
DOIs
StatePublished - Dec 2011

Keywords

  • adverse events
  • children
  • developmental disabilities
  • endtidal carbon dioxide
  • sedation

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