Capnography and depth of sedation during propofol sedation in children.
OBJECTIVE
To evaluate the relationship between continuous capnography and observed airway and respiratory adverse effects and the depth of sedation when using propofol for pediatric orthopedic procedures.


METHODS
We administered propofol after opioid premedication in a prospective convenience sample of children undergoing orthopedic reduction in our emergency department (ED). All children received supplemental oxygen (1 L/minute by nasal cannula) and continuous capnography and had depth of sedation assessed every 2 minutes. Adverse airway or respiratory events and any associated interventions were recorded.


RESULTS
Adverse airway or respiratory events with intervention occurred in 14 of the 125 enrolled children (11%; 95% confidence interval 4.0% to 14%): jaw thrust in 4, supplemental oxygen in 6, and bag-valve-mask ventilation in 4. All interventions required were brief (<30 seconds). Capnography detected apnea before clinical examination or pulse oximetry in all 5 occurrences and similarly first detected airway obstruction in 6 of the 10 occurrences. The median maximal modified Ramsay score was 6 (range 3 to 8), ie, deep sedation.


CONCLUSIONS
When propofol is administered for ED deep sedation to facilitate pediatric orthopedic reduction, continuous capnography detects most airway and respiratory events leading to intervention before clinical examination or pulse oximetry.
Anderson
Jana L
JL
Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT, USA. jana.anderson@hsc.utah.edu
Junkins
Edward
E
Pribble
Charles
C
Guenther
Elisabeth
E
D000293:Adolescent; D001134:Arm Injuries / Q000601:surgery; D019296:Capnography; D002648:Child; D016292:Procedural Sedation; D004636:Emergency Service, Hospital; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D006993:Hypnotics and Sedatives; D019637:Orthopedic Procedures; D010092:Oximetry; D010102:Oxygen Inhalation Therapy; D015742:Propofol; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000209:etiology
D006993:Hypnotics and Sedatives; D015742:Propofol