THE VALUE OF END-TIDAL CO2 MONITORING WHEN COMPARING 3 METHODS OF CONSCIOUS SEDATION FOR CHILDREN UNDERGOING PAINFUL PROCEDURES IN THE EMERGENCY DEPARTMENT

Background: Many studies have evaluated conscious sedation regimens co mmonly used in pediatric patients, Recent advances in capnography equi pment now enable physicians to assess respiratory parameters, specific ally end-tidal CO2 (et-CO2) more accurately in spontaneously breathing sedated children than was possible in the earlier studies, This study was designed to: 1) compare the safety and efficacy of intravenous fe ntanyl, intravenous fentanyl combined with midazolam, and intramuscula r meperidine-promethazine-chlorpromazine (MPC) compound when used for painful emergency department (ED) procedures; and 2) to determine whet her the addition of et-CO2 monitoring enabled earlier identification o f respiratory depression in this population. Methods: Forty-two childr en requiring analgesia and sedation for painful ED procedures were ran domly assigned to receive either fentanyl, fentanyl-midazolam, or MPC compound, Vital signs, oxygen saturation, and et-CO2 were monitored co ntinuously, Pain, anxiety, and sedation scores were recorded every fiv e minutes. Results: Respiratory depression (O-2 saturation less than o r equal to 90% for over one minute or any et-CO2 greater than or equal to 50) occurred in 20% of fentanyl, 23% of fentanyl-midazolam, and 11 % of MPC patients (P = NS), Of those patients manifesting respiratory depression, 6/8 were detected by increased et-CO2 only, MPC patients r equired significantly longer periods of time to meet discharge criteri a than fentanyl and fentanyl-midazolam patients (P < 0.05). No differe nces were noted in peak pain, anxiety, or sedation scores, Conclusions : Fentanyl, fentanyl-midazolam, and MPC produced a high incidence of s ubclinical respiratory depression, End-tidal CO2 monitoring provided a n earlier indication of respiratory depression than pulse oximetry and respiratory rate alone, MPC administration resulted in a significantl y delayed discharge from the ED.