Abstract
Study Objective: To assess the accuracy of respiration rate measurements and the ability to detect apnea by capnometry, impedance pneumography and a new method, acoustic respiration rate monitoring, in anesthetized patients undergoing gastrointestinal endoscopy procedures. Design: Prospective observational study. Setting: Endoscopy procedures laboratory. Patients: 98 patients scheduled for upper gastrointestinal endoscopy with propofol-based anesthesia. Interventions: Patients were monitored for respiration rate with acoustic respiration rate monitoring, capnometry and impedance pneumography and values were compared to the manual counting of breaths by observation of chest wall movements. Additionally, when any respiration rate monitor indicated a cessation of breathing for 30 seconds or greater, the presumed apnea was confirmed by direct observation of the patient for absence of chest wall movements. Measurements and Main Results: Bias and precision for respiration rate measurement was 0 ± 1.0 bpm for acoustic monitoring, 4.8 ± 15.1 bpm for capnometry and 0.4 ± 5.9 bpm for impedance pneumography. Sensitivity and specificity for detection of apnea was 73% and 93% for acoustic monitoring, 73% and 12% for capnometry and 45% and 93% for impedance pneumography. Conclusions: Acoustic respiration rate monitoring was found to be accurate for assessment of respiration rate and to have similar or better sensitivity and specificity for detection of apnea compared to capnometry and impedance pneumography in the setting of upper GI endoscopy.
Highlights
Apnea and respiratory depression are common occurrences during upper GI endoscopy under propofol anesthesia [1]
Interventions: Patients were monitored for respiration rate with acoustic respiration rate monitoring, capnometry and impedance pneumography and values were compared to the manual counting of breaths by observation of chest wall movements
Acoustic respiration rate monitoring was found to be accurate for assessment of respiration rate and to have similar or better sensitivity and specificity for detection of apnea compared to capnometry and impedance pneumography in the setting of upper GI endoscopy
Summary
Apnea and respiratory depression are common occurrences during upper GI endoscopy under propofol anesthesia [1]. There are very few studies looking at the incidence of apnea during GI endoscopy but many cases of dangerous apnea reported in GI endoscopy literature. The incidence of apnea in patients undergoing complex upper GI endoscopic procedures under conscious sedation was found to be 57% in one study [2]. Hypoxemia was the most commonly reported adverse event, occurring in approximately 13% of advanced endoscopic procedures with propofol [3]. The American Society of Anesthesiologists mandates the monitoring of respiration by measuring end tidal carbon dioxide during procedural sedation and anesthesia [4].
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