The role of capnography in the safe sedation in patients undergoing endoscopic retrograd colangio pancreatography (ERCP)

Our aim in our study is to evaluate the effect of capnography monitorization in addition to routine monitorization on oxygen desaturation, hypoxemia and other vital parameters in patients undergoing ERCP under sedation. Eighty patients aged 18 and over who underwent ERCP with sedation were included in our study. Cases were divided into two groups: a group who underwent both routine and capnographic monitorization and a control group who only underwent routine monitorization. Presence of desaturation, hypoxemia, tachycardia, bradycardia and maneuvers for airway management are compared both quantitively and qualitatively between these two groups. Increase and decrease in end-tidal carbondioxide (EtCO2) levels, hypoxemia, desaturation, Integrated Pulmonary Index (IPI) levels requiring attention (5-7) and intervention (1-4) were determined in experiment group, frequencies and possible relations between each of them and other paramaters were assessed. No desaturation was observed in patient group. Prevalance of desaturation was significantly higher in control group compared to patient group (p<0,05). In patient group, more verbal-tactile stimulation was performed (p<0,05). There was no significant difference between groups, regarding hypoxemia, bradycardia, tachycardia and other maneuvers. In patient group, %67,5 of patients (27/40) had low EtCO2, %5 (2/40) had high EtCO2, %27,5 (11/40) had apnea, %37,5 (15/40) had IPI scores requiring attention and %32,5 (13/40) had IPI scores requiring intervention. In one patient who developed hypoxemia, IPI was in 1-4 interval. A statistically significant relationship was found between IPI scores requiring attention and verbal-tactile stimulation (p<0,05). IPI scores requiring intervention were significantly related to apnea-bradypnea development, verbal-tactile stimulation, jaw-thrust maneuver (JTM), head-tilt maneuver (HTM) also (p<0,05). In ERCP patients who are sedated, respiratory depression can be recognised early with close monitorization of EtCO2, apnea and IPI parameters. Additional usage of capnography can reduce the risk of oxygen desaturation in sedatised ERCP patients. Key words: Endoscopic retrograde cholangio pancreatography, ERCP, sedation, capnography, end-tidal carbondioxide, EtCO2.