The effects of capnography during sedation in pediatric esophagogastroduodenoscopy procedures: A randomized controlled study

Background and Aims: Microstream capnography monitors are devices that use nasal sample lines to measure pulse oximeter and end-tidal carbon dioxide values of spontaneously breathing patients. Research suggests that capnography is a more sensitive measure of ventilation than standard modalities. This study aimed to determine whether adding capnography to standard monitoring improves the detection of respiratory depression in children undergoing esophagogastroduodenoscopy with sedation before hypoxemia occurs. Materials and Methods: We enrolled 100 children undergoing esophagogastroduodenoscopy with sedation in a pediatric endoscopy department. All children received standard monitoring and capnography and were randomized to study (n = 50; capnography monitor) and control (n = 50; blind to monitor) groups. The primary outcome was an oxygen desaturation rate < 90%. Results: The control group had higher rates of hypoventilation and oxygen desaturation per minute and received more interventions than the study group. Untimely interventions with hypoventilation were associated with oxygen desaturation < 90%. All episodes of hypoventilation were due to hypopnea; however, medication, gender, and sedation duration were not significantly associated with this outcome. Conclusion: Hypoventilation is common during sedation of pediatric patients undergoing esophagogastroduodenoscopy. Capnography monitoring provides fewer but timely interventions for apnea and hypoventilation and improves the quality of care during sedation. We, therefore, highly recommend the use of capnography monitoring.