THE VALUE OF END-TIDAL CO2 MONITORING WHEN COMPARING 3 METHODS OF CONSCIOUS SEDATION FOR CHILDREN UNDERGOING PAINFUL PROCEDURES IN THE EMERGENCY DEPARTMENT
Ls. Hart et al., THE VALUE OF END-TIDAL CO2 MONITORING WHEN COMPARING 3 METHODS OF CONSCIOUS SEDATION FOR CHILDREN UNDERGOING PAINFUL PROCEDURES IN THE EMERGENCY DEPARTMENT, Pediatric emergency care, 13(3), 1997, pp. 189-193
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.