Journal of Medicine and Palliative Care (JOMPAC) is an open access scientific journal with independent, unbiased, and double-blind review under international guidelines. The purpose of JOMPAC is to contribute to the literature by publishing articles on health sciences and medicine.

EndNote Style
Original Article
Does end-tidal carbon dioxide monitoring in gastrointestinal endoscopy have a clinical advantage?
Aims: In current guidelines recommended CO2 monitoring for patient safety and comfort in sedation for gastrointestinal endoscopy. We aimed to investigate whether carbon dioxide monitoring, which was developed for the early detection of adverse respiratory events shows the expected benefit in its clinical use. Methods: ASA I-II patients, average age 48±15, were divided into two groups, standard monitoring was performed on Group S (n=30), and EtCO2, Integrated Pulmonary Index measurements were added to the Group K (n=30). Patients received Fentanyl 1µgr/kg, propofol 1 mg/kg and propofol 10-30 mg in a bolus by providing BIS to be 60-85. Adverse respiratory events were recorded. The time to Fast-tracking score being 14 was recorded and patients with two consecutive Fast-tracking scores of 14 were discharged. Patient satisfaction was questioned the next day. Results: There is no difference between groups in heart rate and mean arterial pressure, and decreased during the procedure compared to baseline in both groups. While EtCO2 was similar at all times, IPI was lower than baseline. While the processing time was 21±6 in Group S, it was 38±11 in Group K. No adverse respiratory events occurred. Recovery heart rates, peripheral oxygen saturation, mean arterial pressure and scores were similar. There was no difference in patient satisfaction. Conclusions: There wasn’t a clinical advantage with measuring EtCO2 added to the standard monitoring in gastrointestinal tract endoscopy. We believe that more studies are needed on optimum monitoring during moderate sedation in patients with less clinical risk.

1. Ferreira AO, Cravo M. Sedation in gastrointestinal endoscopy:Where are we at in 2014?. World J Gastrointest Endosc.2015;7(2):102-109. doi:10.4253/wjge.v7.i2.102
2. ASGE Standards of Practice Committee, Early DS, Lightdale JR,et al. Guidelines for sedation and anesthesia in GI endoscopy.Gastrointest Endosc. 2018;87(2):327-337.
3. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emergingconsensus on rating quality of evidence and strength ofrecommendations. BMJ. 2008;336(7650):924-926. doi:10.1136/bmj.39489.470347.AD
4. Weaver J. The latest ASA mandate: CO(2) monitoring formoderate and deep sedation. Anesth Prog. 2011;58(3):111-112.doi:10.2344/0003-3006-58.3.111
5. Liu SK, Chen G, Yan B, Huang J, Xu H. Adverse Respiratoryevents increase post-anesthesia care unit stay in China: a2-year retrospective matched cohort study. Curr Med Sci.2019;39(2):325-329. doi:10.1007/s11596-019-2038-y
6. Lubarsky DA. Fast track in the postanesthesia care unit:unlimited possibilities?. J Clin Anesth. 1996;8(3 Suppl):70S-72S.doi:10.1016/s0952-8180(96)90016-1
7. Dossa F, Megetto O, Yakubu M, Zhang DDQ, Baxter NN. Sedationpractices for routine gastrointestinal endoscopy: a systematicreview of recommendations. BMC Gastroenterol. 2021;21(1):22.Published 2021 Jan 7. doi:10.1186/s12876-020-01561-z
8. Wehrmann T, Riphaus A. Sedation with propofol forinterventional endoscopic procedures: a risk factor analysis.Scand J Gastroenterol. 2008;43(3):368-374.
9. Waring JP, Baron TH, Hirota WK, et al. Guidelines for conscioussedation and monitoring during gastrointestinal endoscopy.Gastrointest Endosc. 2003;58(3):317-322. doi:10.1067/s0016-5107(03)00001-4
10. Waugh JB, Epps CA, Khodneva YA. Capnography enhancessurveillance of respiratory events during procedural sedation: ameta-analysis. J Clin Anesth. 2011;23(3):189-196. doi:10.1016/j.jclinane.2010.08.012
11. Klare P, Reiter J, Meining A, et al. Capnographic monitoring ofmidazolam and propofol sedation during ERCP: a randomizedcontrolled study (EndoBreath Study). Endoscopy. 2016;48(1):42-50. doi:10.1055/s-0034-1393117
12. Beitz A, Riphaus A, Meining A, et al. Capnographic monitoringreduces the incidence of arterial oxygen desaturation andhypoxemia during propofol sedation for colonoscopy:a randomized, controlled study (ColoCap Study). Am JGastroenterol. 2012;107(8):1205-1212. doi:10.1038/ajg.2012.136
13. Qadeer MA, Vargo JJ, Dumot JA, et al. Capnographicmonitoring of respiratory activity improves safety of sedationfor endoscopic cholangiopancreatography and ultrasonography.Gastroenterology. 2009;136(5):1568-1820. doi:10.1053/j.gastro.2009.02.004
14. Taft A, Ronen M, Epps C, Waugh J, Wales R. A novel integratedpulmonary index (IPI) quantifies heart rate, EtcO2, respiratoryrate and SpO2. Anesthesiology. 2008;(A1682):109.
15. Ronen M, Weissbrod R, Overdyk FJ, Ajizian S. Smart respiratorymonitoring: clinical development and validation of the IPI™(Integrated Pulmonary Index) algorithm. J Clin Monit Comput.2017;31(2):435-442. doi:10.1007/s10877-016-9851-7
16. Garah J, Adiv OE, Rosen I, Shaoul R. The value of integratedpulmonary index (IPI) monitoring during endoscopies inchildren. J Clin Monit Comput. 2015;29(6):773-778. doi:10.1007/s10877-015-9665-z
17. Yıldırım Ar A, Abitağaoğlu S, Turan G, et al. Integratedpulmonary index (IPI) monitorization under sedation in cataractsurgery with phacoemulsification technique. Int Ophthalmol.2019;39(9):1949-1954. doi:10.1007/s10792-018-1024-x
18. Riphaus A, Wehrmann T, Kronshage T, et al. Clinical value of theintegrated pulmonary index® during sedation for interventionalupper GI-endoscopy: a randomized, prospective tri-center study.Dig Liver Dis. 2017;49(1):45-49. doi:10.1016/j.dld.2016.08.124
19. Oba S, Türk HŞ, Canan TI, Sayın P, Kılınç L. Safety ofmicrostream capnography monitoring in patients under sedationfor colonoscopy. Med Bull Haseki 2019;57(3):232-239
20. Zhang H, Lu Y, Wang L, et al. Bispectral index monitoring of sedationdepth during endoscopy: a meta-analysis with trial sequentialanalysis of randomized controlled trials. Minerva Anestesiol.2019;85(4):412-432. doi:10.23736/S0375-9393.18.13227-5
Volume 4, Issue 5, 2023
Page : 505-510