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Monitoring standards in sedation and analgesia

the odyssey of capnography in sedation for gastroenterology procedures

Wadhwa, Vaibhava; Gupta, Kapilb; Vargo, John J.c

Current Opinion in Anesthesiology: August 2019 - Volume 32 - Issue 4 - p 453–456
doi: 10.1097/ACO.0000000000000756
DRUGS IN ANESTHESIA: Edited by Ken B. Johnson

Purpose of review Capnography is an excellent tool for early detection of hypoxemia and apnea in patients undergoing sedation for gastrointestinal endoscopy. The current American Society of Anesthesiology (ASA) guidelines recommend the use of capnography in any patient undergoing moderate sedation. The purpose of this review was to compile the most recent data available on capnography use in gastrointestinal endoscopy with the focus primarily on the use of capnography in moderate sedation cases.

Recent findings Recent high-quality studies have evaluated the utility of capnography in low risk patients undergoing moderate sedation and have found no benefit with addition of capnography.

Summary Capnography is beneficial when used for patients who are at a higher risk for sedation-related complications. There is no benefit when capnography is used in low risk patients undergoing routine upper endoscopy and colonoscopy under moderate sedation but there is benefit when used in advanced endoscopic procedures that require deeper sedation and have longer procedure times.

aDepartment of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston

bDepartment of Internal Medicine, JFK Medical Center, University of Miami, Atlantis, Florida

cDepartment of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA

Correspondence to John J. Vargo, MD, MPH, Director, Endoscopy Operations Enterprise, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Tel: +1 216 445 5012; e-mail:

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