End-tidal carbon dioxide monitoring in the detection of anesthesia-related critical incidents.

A prospective study was undertaken in an effort to determine the usefulness of the end-tidal carbon dioxide monitor in detecting anesthesia-related critical incidents. The critical incident technique was employed in the evaluation of 2,334 anesthetics. Anesthesia providers completed a critical incident questionnaire following each anesthetic. All questionnaires were analyzed for the occurrence of a critical incident. The anesthesia provider was interviewed and the patient record reviewed in all cases of reported critical incidents to determine (1) the frequency of specific anesthesia-related critical incidents, and (2) the usefulness of the end-tidal carbon dioxide monitor in detecting such events. The critical incident technique revealed 79 such incidents. Monitoring of end-tidal carbon dioxide was found to be useful in confirming the occurrence of already suspected critical incidents 58% of the time. The end-tidal carbon dioxide monitor was also found to be the initial detector of 27% of the reported anesthesia-related critical incidents. Monitoring of end-tidal carbon dioxide proved to be beneficial in detecting and confirming critical incidents during anesthetic management.