Yarchi Daniel, Cohen Ayala, Umansky Tatiana, Sukhotnik Igor, Shaoul Ron
Anesthesia Department, Faculty of Industrial Engineering and Management, Technion, Haifa, Israel.
Gastrointest Endosc. 2009 Apr;69(4):877-82. doi: 10.1016/j.gie.2008.05.054. Epub 2008 Nov 18.
Pulse oximetry has become the standard of care during endoscopic procedures, despite the fact that significant alveolar hypoventilation may be undetected.
To study the value of end-tidal carbon dioxide (EtCO(2)) measurement during pediatric and adult endoscopic procedures with the patient under general anesthesia (GA) and conscious sedation (CS).
Oridion Microcap hand-held capnography by using Smart Bite Bloc with oxygen (O(2)) delivery were used for the procedures. Microstream nondispersive infrared (IR) spectroscopy is used to measure the concentration of molecules that absorb IR light in CO(2) exhaled by the subject. For each patient, we defined an "event" based on a combination of a >or=20% change (increase or decrease) in EtCO(2), with at least one of the following: O(2) saturation (SPO(2)) <or=90%, a >or=20% change of pulse rate or respiratory rate.
We studied 57 patients, with an age range of 4 to 62 years. Nineteen patients (33.3%) had CS and 38 (66.6%) had GA.
Twenty patients had no events, 32 had 1 event, and 5 patients had 2 events. The highest observed frequency of an event was noted during upper endoscopy under GA (0.35), followed by upper endoscopy under CS (0.32). Fitted univariate logistic regression models indicated that higher variability in EtCO(2) is associated with a higher probability for an event (P < .0001) and that an increase in age is associated with a lower probability for an event (P < .0001). Significant differences in the frequencies of SPO(2) events were related to the type of procedure (P = .0002; highest estimated probability for upper endoscopy) and GA (P < .0001). Similar conclusions were obtained based on the fitted multivariate model.
EtCO(2) contributes significantly to the prediction of events during endoscopy. A lower mean of EtCO(2), higher variability of EtCO(2), younger age, GA, and upper endoscopy increase the probability of an event.
尽管脉搏血氧饱和度测定法可能无法检测到显著的肺泡通气不足，但它已成为内镜检查过程中的标准护理手段。
研究在全身麻醉（GA）和清醒镇静（CS）下，小儿及成人内镜检查过程中呼气末二氧化碳（EtCO₂）测量的价值。
使用带有氧气（O₂）输送装置的Oridion Microcap手持式二氧化碳监测仪，通过智能咬嘴进行操作。采用微流非分散红外（IR）光谱法测量受试者呼出的二氧化碳中吸收红外光的分子浓度。对于每位患者，我们根据EtCO₂变化≥20%（增加或减少）并伴有以下至少一项来定义一个“事件”：氧饱和度（SPO₂）≤90%、脉搏率或呼吸率变化≥20%。
我们研究了57例患者，年龄范围为4至62岁。19例患者（33.3%）接受清醒镇静，38例（66.6%）接受全身麻醉。
20例患者未发生事件，32例发生1次事件，5例发生2次事件。事件的最高观察频率出现在全身麻醉下的上消化道内镜检查中（0.35），其次是清醒镇静下的上消化道内镜检查（0.32）。拟合的单变量逻辑回归模型表明，EtCO₂的较高变异性与事件发生的较高概率相关（P <.0001），年龄增加与事件发生的较低概率相关（P <.0001）。SPO₂事件频率的显著差异与检查类型（P =.0002；上消化道内镜检查的估计概率最高）和全身麻醉（P <.0001）有关。基于拟合的多变量模型得出了类似结论。
EtCO₂对内镜检查期间事件的预测有显著贡献。EtCO₂的较低平均值、较高变异性、较年轻的年龄、全身麻醉和上消化道内镜检查会增加事件发生的概率。
