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Title Inclusion of Capnography Monitoring During Conscious Sedation May Lead to Reduction in Respiratory Compromise
Clinical Question In patients undergoing conscious sedation, is capnography monitoring more effective than pulse oximetry in preventing hypoxemia?
Clinical Bottom Line Capnography monitoring is associated with less O2 desaturation than monitoring with visual assessment and pulse oximetry alone.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 28667196Saunders/201713 RCTs, 14 pt groupsMeta-Analysis
Key resultsThis study found that inclusion of capnography monitoring in procedural sedation and analgesia (PSA) significantly reduced mild desaturation (RR 0.77, 95% CI 0.67 to 0.89), and severe desaturation (RR 0.59, 95% CI 0.43 to 0.81). Analysis of limited data from moderate sedation studies only still showed a reduction in mild desaturation (RR 0.80, 95% CI 0.60 to 1.07), although this reduction was non-significant.
#2) 32556657Askar/202014 RCTsMeta-Analysis
Key resultsCapnography monitoring reduced the incidence of hypoxemia during procedural sedations. The capnography monitoring group “showed a lower incidence of hypoxemia (RR 0.76, 95% CI 0.70 to 0.83, p < 0.001) and the episodes of oxygen desaturation (RR 0.79, 95% CI 0.71 to 0.87, p < 0.001) compared with the oximetry monitoring group.”
#3) 29304910Parker/201816 RCTs, 3866 adultsMeta-Analysis
Key resultsWhen studies that included deeply sedated patients were excluded from analysis, capnography monitoring showed higher sensitivity (0.90, 95% CI 0.42 to 0.99) and specificity (0.88, 95% CI 0.57 to 0.97) in detecting adverse respiratory events than did standard monitoring alone. The overall relative risk of developing hypoxemia with capnography monitoring was 0.69 (95% CI, 0.57 to 0.82). Capnography did not increase the risk of developing serious adverse events, procedure time, sedation quality, or patient satisfaction.
Evidence Search PubMed + TRIP search terms: capnography and sedation and dentistry
Comments on
The Evidence
It is important to remember that procedural sedation and analgesia (PSA), described in all three studies, can include both moderate and deep sedation. Moderate sedation and conscious sedation are used synonymously. Saunders et al., 2017 used PubMed, the Cochrane Library, and EMBASE for literature search. This article reviewed procedural sedation and anesthesia in general. Only 5/14 pt groups were treated with medications typically associated with moderate sedation. Askar et al., 2020 included a well-defined PICO question. In the literature search, this study had high interrater reliability for titles and abstracts (k = 0.93) and full-text articles (k= 0.98). 7/14 patient groups were treated with medications associated with moderate sedation. There is no statistical separation of moderate and deep sedation groups. Parker et al., 2018 conducted a rapid review and meta-analysis. While rapid reviews aim to be rigorous and explicit in method, curtailing the duration of the review process may introduce additional bias as compared to systematic review. 4/16 studies used medications for moderate sedation. The strength of this research includes a relatively large overall sample size (N=3,866) and the separation of moderately and deeply sedated patients in the analysis.
Applicability Adverse events during conscious sedation are often related to poor ventilation. Training and instructing dental providers on using capnography monitoring could help in reducing adverse events.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics)
Keywords capnography, sedation, dentistry
ID# 3483
Date of submission: 11/30/2021spacer
E-mail Lambm2@livemail.uthscsa.edu
Author Michael Lamb, DMD
Co-author(s) Emily Sexton, DDS
Co-author(s) e-mail sextone@livemail.uthscsa.edu
Faculty mentor/Co-author Ernest Luce, DDS
Faculty mentor/Co-author e-mail Luce@uthscsa.edu
Basic Science Rationale
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