Valbuena Isabel, Sancho Azahara, Alsina Estíbaliz, Brogly Nicolás, Gilsanz Fernando
Department of Anaesthesiology and Intensive Care Medicine, Hospital Universitario La Paz, Madrid, Spain.
CEU University, Madrid, Spain.
J Clin Monit Comput. 2025 May 26. doi: 10.1007/s10877-025-01299-7.
This study aimed to determine whether the use of capnography reduces the incidence of respiratory and cardiovascular adverse events during procedural sedation and analgesia (PSA) for gastrointestinal endoscopic procedures (GEP) provided by experienced anaesthesiologists. A prospective cohort study was conducted, including patients undergoing GEP under PSA. Patients were divided in two groups: Group A (pulse oximetry) and Group B (capnography with Capnostream monitor plus pulse oximetry). Interventions undertaken to resolve hypoxaemia, airway obstruction, or apnoea were recorded. Age, comorbidities, ASA Classification, sedative drugs, respiratory and cardiovascular adverse events, recovery Aldrete Scale value, and patient satisfaction were also recorded. Both parametric and non-parametric tests were applied. A total of 1,146 patients were included: Group A, n = 538, and Group B, n = 608. Diagnostic colonoscopy was the most frecuent procedure (49.7%), followed by diagnostic gastroscopy (22.5%) and therapeutic colonoscopy (22.2%). Apnoea < 60 s was detected only in patients monitored with capnography (35.4% vs. 0%, p < 0.000). The use of capnography significantly reduced the incidence of moderate hypoxaemia (3% vs. 6.5%, p = 0.004). Severe hypoxaemia was significantly reduced with capnography only in patients with cardio-respiratory comorbidities (2.2% vs. 4.4%, p = 0.032). The capnography group showed a lower incidence of cardiovascular events. Respiratory adverse events, such as desaturation and airway obstruction, increased with age and ASA classification, as did the need for airway maneuvers. Prolonged apnoea and intubation were rare in both groups. Mandibular traction manoeuvres were significantly more frequent in Group B (9.9% vs. 3%, p < 0.000), reducing the need for other interventions. Patient satisfaction at discharge was higher when capnography was used (p < 0,000). Moderate-deep sedation for GEP performed by experienced anaesthesiologists, combined with capnography, enhances safety, with extremely rare major complications. Capnography monitoring allowed the timely identification and resolution of apnoea and airway obstruction, avoiding severe desaturation and cardiovascular adverse events.
本研究旨在确定在经验丰富的麻醉医生实施的用于胃肠内镜检查（GEP）的程序性镇静镇痛（PSA）过程中，使用二氧化碳监测是否能降低呼吸和心血管不良事件的发生率。进行了一项前瞻性队列研究，纳入了在PSA下接受GEP的患者。患者被分为两组：A组（脉搏血氧饱和度监测）和B组（使用Capnostream监测仪进行二氧化碳监测加脉搏血氧饱和度监测）。记录为解决低氧血症、气道阻塞或呼吸暂停而采取的干预措施。还记录了年龄、合并症、美国麻醉医师协会（ASA）分级、镇静药物、呼吸和心血管不良事件、恢复的Aldrete量表值以及患者满意度。应用了参数检验和非参数检验。共纳入1146例患者：A组，n = 538；B组，n = 608。诊断性结肠镜检查是最常见的操作（49.7%），其次是诊断性胃镜检查（22.5%）和治疗性结肠镜检查（22.2%）。仅在使用二氧化碳监测的患者中检测到呼吸暂停<60秒（35.4%对0%，p < 0.000）。使用二氧化碳监测显著降低了中度低氧血症的发生率（3%对6.5%，p = 0.004）。仅在有心肺合并症的患者中，使用二氧化碳监测使严重低氧血症显著降低（2.2%对4.4%，p = 0.032）。二氧化碳监测组的心血管事件发生率较低。呼吸不良事件，如血氧饱和度下降和气道阻塞，随年龄和ASA分级增加，气道操作的需求也增加。两组中长时间呼吸暂停和插管均罕见。B组下颌牵引操作明显更频繁（9.9%对3%，p < 0.000），减少了对其他干预措施的需求。使用二氧化碳监测时出院时患者满意度更高（p < 0.000）。经验丰富的麻醉医生实施的GEP中度至深度镇静，结合二氧化碳监测，可提高安全性，极少发生严重并发症。二氧化碳监测可及时识别和解决呼吸暂停和气道阻塞，避免严重的血氧饱和度下降和心血管不良事件。
