What Factors Influence Community Oral and Maxillofacial Surgeons' Choice to Use Capnography in the Office-Based Ambulatory Anesthesia Setting?

Abstract

The American Association of Oral and Maxillofacial Surgeons Board of Trustees mandated monitoring using capnography during moderate sedation (MS) and deep sedation or general anesthesia (DS/GA) delivered in the office setting effective January 1, 2014. The purpose of this study was to estimate the frequency of capnography use and to identify variables associated with a clinician's choice to use capnography before the mandate. To address the research purpose, the authors designed a prospective cohort study and enrolled 2 samples: 1) American private practicing oral and maxillofacial surgeons (OMSs) and 2) all eligible patients for whom these OMSs delivered MS or DS/GA. The predictor variables were categorized as surgeon or patient demographics, anesthesia risk factors, procedure-related variables, and anesthetic medications. The outcome variable was capnography use during MS or DS/GA. Descriptive, bivariate, and forward stepwise multiple logistic regression statistics were computed to evaluate the association between the predictor variables and capnography use, with statistical significance set at a P value less than or equal to .05. The surgeon sample was composed of 95 OMSs and 13.7% reported using capnography. The patient sample included 3,495 patients with a mean age of 30.6 years (standard deviation, 17.8 yr), 43.5% were men, and 5.6% were monitored using capnography. Based on bivariate analyses, 17 variables were associated with capnography use. Forward stepwise regression modeling identified 9 variables statistically associated with capnography use. These variables were patient's age, Mallampati airway score, alcohol consumption, board certification, sevoflurane use, number of monitoring methods, electrocardiogram use, precordial stethoscope use, and number of personnel in operating suite. Although this study might be of historical interest at this time, the results offer insight into OMSs' practice patterns before the mandatory requirement to use capnography. As more OMSs comply with the capnography mandate, their practice patterns involving variables found to statistically correlate with capnography use might become more similar to those of early adopters of this technology.