TY - JOUR
T1 - Utility of endtidal carbon dioxide monitoring in detection of hypoxia during sedation for brain magnetic resonance imaging in children with developmental disabilities
AU - Kannikeswaran, Nirupama
AU - Chen, Xinguang
AU - Sethuraman, Usha
PY - 2011/12
Y1 - 2011/12
N2 - 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.
AB - 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.
KW - adverse events
KW - children
KW - developmental disabilities
KW - endtidal carbon dioxide
KW - sedation
UR - http://www.scopus.com/inward/record.url?scp=80055011844&partnerID=8YFLogxK
U2 - 10.1111/j.1460-9592.2011.03660.x
DO - 10.1111/j.1460-9592.2011.03660.x
M3 - Article
C2 - 21824212
AN - SCOPUS:80055011844
VL - 21
SP - 1241
EP - 1246
JO - Paediatric Anaesthesia
JF - Paediatric Anaesthesia
SN - 1155-5645
IS - 12
ER -