Pulse oximetry and capnography in anaesthetic practice: an epidemiological appraisal

In the evaluation of any medical technology the efficacy, effectiveness, and efficiency must each be considered before routine deployment is recommended. Since the widespread practice of patient monitoring by pulse oximetry and capnography has occurred before the performance of rigorously controlled trials, definitive proof of worth is lacking. The purpose of this review is to appraise critically the effectiveness of this technology. The assessment was performed using concepts developed in epidemiology and community medicine to establish a given factor to be causative to a given outcome. The current literature pertaining to anaesthetic adverse outcomes was reviewed, and the use of monitors evaluated against the criteria of a causal relationship. While the conclusions are based more on the absence of positive data (owing to low frequency of adverse anaesthetic occurrences) rather than negative results, it must be concluded that the effectiveness of such monitoring has yet to be demonstrated. Such a conclusion should not detract from their use, for the role of an individual factor in the complex chain of accident evolution will seldom be demonstrable. Rather, such an appraisal should encourage a clear perspective of the depth of our clinical science, and encourage more rigorous critical evaluation in the future.