Emergency and critical care medicineNovel monitoring techniques for use with procedural sedationLevine, Deborah Aa; Platt, Shari Lb Author Information aDepartments of Pediatrics and Emergency Medicine, New York University School of Medicine, Bellevue Hospital Center, New York, New York, and bDepartments of Pediatrics and Emergency Medicine, New York Weill Cornell Medical Center, New York, New York, USA Correspondence to Deborah Levine MD, FAAP, Division of Pediatric Emergency Medicine, Department of Pediatrics, Bellevue Hospital Center, 27th Street and First Avenue, Room 1 South 6, New York, NY 10016, USA Tel: 212 562 8149 e-mail: [email protected] Current Opinion in Pediatrics: June 2005 - Volume 17 - Issue 3 - p 351-354 doi: 10.1097/01.mop.0000163694.03726.20 Buy Metrics Abstract Purpose of review A variety of pharmacologic agents used for procedural sedation in children to reduce pain and anxiety may produce respiratory depression and hypotension. Although standard monitoring guidelines include oxygen saturation, this measurement is limited as a guide to respiratory function. This review discusses two new monitoring techniques recently introduced to the pediatric emergency department that facilitate procedural sedation and reduce potential adverse effects of the medications administered. Recent findings Capnography via an end-tidal carbon dioxide monitor measures carbon dioxide concentrations during ventilation. This measurement is independent of oxygen saturation and thereby aids the clinician in identifying hypoventilation and apnea in the sedated patient at an earlier stage than conventional monitoring. The bispectral index monitor objectively measures the depth of sedation by analyzing electroencephalogram signals from a cutaneous probe. This tool enables the physician to titrate sedative medications to a desired effect and thereby reduce the risks associated with oversedation. Summary Studies have illustrated the use of both devices as adjuncts to current standard monitoring of children in the outpatient setting. These modalities will facilitate the efficacy of procedural sedation in children and improve safety by enabling early recognition of hypoventilation and by reducing the risk of oversedation in children undergoing procedural sedation. © 2005 Lippincott Williams & Wilkins, Inc.