Gastrointestinal endoskopide end-tidal karbon dioksit monitorizasyonunun klinik avantajı var mıdır? Randomize klinik çalışma

Yıl 2023, Cilt: 4 Sayı: 5, 505 - 510, 27.10.2023

Mesure Gül Nihan Özden , Serpil Karslı , Nurten Bakan

https://doi.org/10.47582/jompac.1346914

Öz

Amaç: Mevcut kılavuzlarda gastrointestinal endoskopi için sedasyonda hasta güvenliği ve konforu için CO2 monitörizasyonu önerilmektedir. Olumsuz solunum olaylarının erken saptanması için geliştirilen karbondioksit monitorizasyonunun klinik kullanımında beklenen faydayı gösterip göstermediğini araştırmayı amaçladık.
Yöntemler: Yaş ortalaması 48±15 olan Asa I-II hastaları iki gruba ayrıldı, Grup S'ye (n=30) standart monitörizasyon uygulandı ve Grup K'ye (n=30) EtCO2, Entegre Pulmoner İndeks ölçümleri eklendi. Sedasyon amaçlı Fentanil 1µgr/kg, propofol 1 mg/kg ve sonrasında gerektikçe propofol 10-30 mg bolus BIS 60-85 olacak şekilde amaçlanarak verildi. Olumsuz solunum olayları kaydedildi. Fast-tracking skorunun 14 olduğu süre kaydedildi ve arka arkaya iki Fast-tracking skoru 14 olan hastalar taburcu edildi. Ertesi gün hasta memnuniyeti sorgulandı.
Bulgular: Kalp hızı ve ortalama arter basıncı açısından gruplar arasında fark yoktu ve her iki grupta da işlem sırasında başlangıca göre azaldı. EtCO2 her zaman benzerken, IPI başlangıçtan daha düşüktü. İşlem süresi Grup S'de 21±6 iken Grup K'de 38±11 idi. Herhangi bir olumsuz solunum olayı yaşanmadı. İyileşme kalp hızları, periferik oksijen satürasyonu, ortalama arter basıncı ve skorları benzerdi. Hasta memnuniyetinde fark yoktu.
Sonuç: Gastrointestinal sistem endoskopisinde standart monitörizasyona EtCO2 ölçümü eklenmesinin klinik bir avantajı yoktu. Klinik riski daha az olan hastalarda orta şiddette sedasyon sırasında optimum izleme konusunda daha fazla çalışmaya ihtiyaç olduğuna inanıyoruz.

Anahtar Kelimeler

Kapnograf, Gastrointestinal Endoskopi, Sedasyon

Does end-tidal carbon dioxide monitoring in gastrointestinal endoscopy have a clinical advantage?

Öz

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.

Anahtar Kelimeler

Capnography, Gastrointestina Endoscopy, Sedation

Kaynakça

• 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
• 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.
• Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924-926. doi:10.1136/bmj.39489.470347.AD
• Weaver J. The latest ASA mandate: CO(2) monitoring for moderate and deep sedation. Anesth Prog. 2011;58(3):111-112. doi:10.2344/0003-3006-58.3.111
• Liu SK, Chen G, Yan B, Huang J, Xu H. Adverse respiratory events increase post-anesthesia care unit stay in China: a 2-year retrospective matched cohort study. Curr Med Sci. 2019;39(2):325-329. doi:10.1007/s11596-019-2038-y
• 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
• Dossa F, Megetto O, Yakubu M, Zhang DDQ, Baxter NN. Sedation practices for routine gastrointestinal endoscopy: a systematic review of recommendations. BMC Gastroenterol. 2021;21(1):22. Published 2021 Jan 7. doi:10.1186/s12876-020-01561-z
• Wehrmann T, Riphaus A. Sedation with propofol for interventional endoscopic procedures: a risk factor analysis. Scand J Gastroenterol. 2008;43(3):368-374.
• Waring JP, Baron TH, Hirota WK, et al. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointest Endosc. 2003;58(3):317-322. doi:10.1067/s0016-5107 (03)00001-4
• Waugh JB, Epps CA, Khodneva YA. Capnography enhances surveillance of respiratory events during procedural sedation: a meta-analysis. J Clin Anesth. 2011;23(3):189-196. doi:10.1016/j.jclinane.2010.08.012
• Klare P, Reiter J, Meining A, et al. Capnographic monitoring of midazolam and propofol sedation during ERCP: a randomized controlled study (EndoBreath Study). Endoscopy. 2016;48(1):42-50. doi:10.1055/s-0034-1393117
• Beitz A, Riphaus A, Meining A, et al. Capnographic monitoring reduces the incidence of arterial oxygen desaturation and hypoxemia during propofol sedation for colonoscopy: a randomized, controlled study (ColoCap Study). Am J Gastroenterol. 2012;107(8):1205-1212. doi:10.1038/ajg.2012.136
• Qadeer MA, Vargo JJ, Dumot JA, et al. Capnographic monitoring of respiratory activity improves safety of sedation for endoscopic cholangiopancreatography and ultrasonography. Gastroenterology. 2009;136(5):1568-1820. doi:10.1053/j.gastro. 2009.02.004
• Taft A, Ronen M, Epps C, Waugh J, Wales R. A novel integrated pulmonary index (IPI) quantifies heart rate, EtcO2, respiratory rate and SpO2. Anesthesiology. 2008;(A1682):109.
• Ronen M, Weissbrod R, Overdyk FJ, Ajizian S. Smart respiratory monitoring: 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
• Garah J, Adiv OE, Rosen I, Shaoul R. The value of integrated pulmonary index (IPI) monitoring during endoscopies in children. J Clin Monit Comput. 2015;29(6):773-778. doi:10.1007/s10877-015-9665-z
• Yıldırım Ar A, Abitağaoğlu S, Turan G, et al. Integrated pulmonary index (IPI) monitorization under sedation in cataract surgery with phacoemulsification technique. Int Ophthalmol. 2019;39(9):1949-1954. doi:10.1007/s10792-018-1024-x
• Riphaus A, Wehrmann T, Kronshage T, et al. Clinical value of the integrated pulmonary index® during sedation for interventional upper GI-endoscopy: a randomized, prospective tri-center study. Dig Liver Dis. 2017;49(1):45-49. doi:10.1016/j.dld.2016.08.124
• Oba S, Türk HŞ, Canan TI, Sayın P, Kılınç L. Safety of microstream capnography monitoring in patients under sedation for colonoscopy. Med Bull Haseki 2019;57(3):232-239
• Zhang H, Lu Y, Wang L, et al. Bispectral index monitoring of sedation depth during endoscopy: a meta-analysis with trial sequential analysis of randomized controlled trials. Minerva Anestesiol. 2019;85(4):412-432. doi:10.23736/S0375-9393.18.13227-5