Mo1358 Can Capnography Reduce Hypoxic Events in Endoscopy Patients Undergoing Nurse Administered Propofol Sedation (NAPS): A Randomized Study

Can Capnography Reduce Hypoxic Events in Endoscopy Patients Undergoing Nurse Administered Propofol Sedation (NAPS): A Randomized Study Charlotte Slagelse, Peter Vilmann, Pernille Hornslet, Tina I. Horsted, Henrik Jorgensen, Anne Hammering Endoscopic unit, Gentofte and Herlev Hospitals, University of Copenhagen, Hellerup, Denmark; Dept of anaesthesiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Clinical Biochemistry, Bispebjerg Hospital, Denmark, Copenhagen NV, Denmark Introduction: During recent years nurses trained in the use of Propofol sedation for endoscopy has been introduced. Propofol has a respiratory depressive effect and according to the literature this may result in hypoxia in 4-6%. Capnographic measurements of carbon dioxide during expiration are able to detect respiratory changes, based on the capnographic curve and value. Therefore, this method potentially detects early respiratory insufficiency before clinical signs of hypoventilation or measurable desaturation is present. Objective: Whether the use of capnography during endoscopy may improve patient safety in patients undergoing NAPS by reducing the number, the severity and the duration of hypoxic events. Materials & Methods: The study population consists of patients eligible for NAPS undergoing endoscopy. The patients were randomized into an intervention group ( capnography) and a control group ( capnography). Carbon dioxide was measured by a standard tube positioned at the nostrils of the patient. Collection of data from the capnograph was continuously loaded into a computer. The NAPS nurse and the endoscopist was able to monitor changes in capnographic curves/values and duration of possible hypoxia during the procedure and were instructed to act according to predefined changes. All patients were monitored with pulse oximetry (SpO2), BP and continuous EKG. The primary outcomes were the number, the duration and the severity of hypoxia defined as SpO2 92 % (no hypoxia), 92-90 %, 90-88 % and 88 %. Results: 259 consecutive patients undergoing GI endoscopic procedures were included and randomized into an intervention group (n 125) and a control group (n 134). Procedures included colonoscopy (149), gastroscopy (61), ERCP (9), EUS (32) and sigmoidoscopy (8). There was no statistically significant difference in the distribution of ASA group, sex, age, weight, height, procedure type, procedure length or Propofol dose between the two groups. The median dose [25th percentile, 75th percentile] of Propofol in the intervention group was 300 [220, 400] mg and in the control group 330mg [230,470]. A significant difference between the groups was found with a lower number of hypoxia in the intervention group (p 0.023, Chi2-test). The cumulated number of hypoxic events showed no cases of hypoxia after 33 min. in the intervention group, whereas the number continued to increase in the control group (fig. 1.). The duration of hypoxic events also showed a tendency towards a higher mean in the control group (27.8 sec) compared with the intervention group (23.4sec) (p 0.45). Conclusion: Capnografic measurements of endoscopic patients undergoing NAPS improves patient safety by decreasing the number of hypoxic events compared with standard monitoring (p 0.023). Capnographic monitoring seems in particular important during procedures exceeding 30 minutes.