Capnography and depth of sedation during propofol sedation in children

Study objective: To evaluate the relationship between continuous capnography and observed airway and respiratory adverse effects and the depth of sedation when using propofol for pediatric orthopedic procedures. Methods: We administered propofol after opioid premedication in a prospective convenience sample of children undergoing orthopedic reduction in our emergency department (ED). All children received supplemental oxygen (1 L/minute by nasal cannula) and continuous capnography and had depth of sedation assessed every 2 minutes. Adverse airway or respiratory events and any associated interventions were recorded. Results: Adverse airway or respiratory events with intervention occurred in 14 of the 125 enrolled children (11%; 95% confidence interval 4.0% to 14%): jaw thrust in 4, supplemental oxygen in 6, and bag-valve-mask ventilation in 4. All interventions required were brief (<30 seconds). Capnography detected apnea before clinical examination or pulse oximetry in all 5 occurrences and similarly first detected airway obstruction in 6 of the 10 occurrences. The median maximal modified Ramsay score was 6 (range 3 to 8), ie, deep sedation. Conclusion: When propofol is administered for ED deep sedation to facilitate pediatric orthopedic reduction, continuous capnography detects most airway and respiratory events leading to intervention before clinical examination or pulse oximetry.