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Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Novel monitoring techniques for use with procedural sedation
Deborah A Levine1, Shari L Platt
1Departments of Pediatrics and Emergency Medicine, New York University School of Medicine, Bellevue Hospital Center, New York, New York 10016, USA. mlevine336@aol.com
Insights
New monitoring techniques, including capnography and bispectral index monitoring, improve procedural sedation safety in children. These methods help detect respiratory depression and titrate sedation, reducing adverse effects.
Area of Science:
- Pediatric Emergency Medicine
- Anesthesiology
- Critical Care
Background:
- Procedural sedation in children can cause respiratory depression and hypotension.
- Standard oxygen saturation monitoring has limitations in assessing respiratory function.
- Newer monitoring techniques offer improved safety during pediatric procedural sedation.
Purpose of the Study:
- To review two novel monitoring techniques for pediatric procedural sedation.
- To discuss how these techniques can mitigate adverse effects of sedative medications.
- To highlight advancements in patient safety during sedation.
Main Methods:
- Capnography measures end-tidal carbon dioxide to detect hypoventilation and apnea.
- Bispectral index (BIS) monitoring analyzes electroencephalogram signals to objectively assess sedation depth.
- These methods are used as adjuncts to standard monitoring in pediatric emergency departments.
Main Results:
- Capnography provides an earlier indication of hypoventilation than oxygen saturation.
- BIS monitoring allows for precise titration of sedative medications, reducing oversedation.
- Both techniques have been shown to be effective in outpatient settings.
Conclusions:
- Capnography and BIS monitoring enhance the safety and efficacy of procedural sedation in children.
- Early recognition of respiratory compromise and optimized sedation levels improve patient outcomes.
- These advanced monitoring modalities are valuable additions to pediatric care.
Purpose Of Review:
A variety of pharmacologic agents used for procedural sedation in children to reduce pain and anxiety may produce respiratory depression and hypotension. Although standard monitoring guidelines include oxygen saturation, this measurement is limited as a guide to respiratory function. This review discusses two new monitoring techniques recently introduced to the pediatric emergency department that facilitate procedural sedation and reduce potential adverse effects of the medications administered.
Recent Findings:
Capnography via an end-tidal carbon dioxide monitor measures carbon dioxide concentrations during ventilation. This measurement is independent of oxygen saturation and thereby aids the clinician in identifying hypoventilation and apnea in the sedated patient at an earlier stage than conventional monitoring. The bispectral index monitor objectively measures the depth of sedation by analyzing electroencephalogram signals from a cutaneous probe. This tool enables the physician to titrate sedative medications to a desired effect and thereby reduce the risks associated with oversedation.
Summary:
Studies have illustrated the use of both devices as adjuncts to current standard monitoring of children in the outpatient setting. These modalities will facilitate the efficacy of procedural sedation in children and improve safety by enabling early recognition of hypoventilation and by reducing the risk of oversedation in children undergoing procedural sedation.
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