Enhancement-of-Procedural-Sedation-Safety-with-Capnography

1. Enhancement of
Procedural Sedation
Safety with Capnography
Implementation of capnography to enhance
procedural sedation safety in local anesthesia
cases within the Queen Elizabeth Hospital (QEH)
operating theatre.
QEH APN Lee Chun Fai, Mark

2. • Advocated the conscious/moderate sedation instead of
minimal sedation
• Requiring trained staff to monitor patients’ depth of
sedation and their end tidal CO2 by capnography device.
Lack guidance, monitoring and control for procedural
sedation safety in Queen Elizabeth hospital operating
theatres.
Updates on Guideline on Procedural
Sedation

3. New Sedation Scoring Form
Why a New Scoring
Form Was Needed
Existing systems lacked
sensitivity, consistency
and were not standardized
Development of the
New Scoring Form
The modified Brussels
Sedation Scale was
chosen to improve
consistency and
sensitivity of the scoring
system, which ranges
from 1 to 5.
Workflow in
Intravenous (IV)
sedation for Local
Anesthesia (LA) case
were established
Elevated consistency and
standardized sedation
documentation

4. Modified Brussels
Sedation Scale

5. Workflow For Local Anesthesia Cases
Standardized Workflow
The new workflow includes
capnography monitoring,
recording of sedation scores,
and oxygen administration.
Timely assessment References
Provides a quick reference in
dealing with the change of
sedation level of the patient.
The use of capnography is
also reminded in the workflow
chart.
Perform a sedation assessment
1. before IV sedation injection,
2. 5 to 10 minutes after the
sedation given,
3. before patient leaving
operating theatre
4. remind the recovery room
nurse to continue the
assessment before the patient
leaves the recovery room.

6. Workflow For Local
Anesthesia Cases

7. Benefits of Capnography in
Procedural Sedation
1 Early Identification of
Respiratory Depression
Capnography is a key
component to detect
respiratory depression
shortly after its onset.
2 Non-invasive
Monitoring Method
Capnography monitoring
has a nearly non-existent
complication rate in
monitoring the ventilation.
3 Documentation of Sedation Level
The sedation score with capnography data can accurately and
consistently reflect patient sedation level.

8. Results
0 5 10 15 20 25 30 35 40
Cystoscopic
Angioplasty
Tenckhoff
Catheter
Typers of operations among IV sedated case
12
3
38

9. With the implementation of the new workflow and devices,
97% of patients successfully underwent sedation
assessment.
• 33% (17 cases) developed a decrease in conscious level
after sedation. Among the patients with decreased
conscious level, 73% (12 cases) dropped in end tidal CO2.
• Positive correlation coefficient ( p = 0.7) between
conscious level and end tidal CO2.
Results

10. Conclusion
• Establishing a quantitative sedation level record with
proper and formal documentation enhances
communication of staff together with the perioperative
safety of patients.
• Using capnography can detect the respiratory distress
earlier than the pulse oximeter. As a result, more timely
nursing intervention could be given to patients in order to
reduce further respiratory deterioration.

11. References
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Professions, 16, 40.
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Quality and Merit. Teaching and Learning in Nursing, 13(1), 9–13.
3. Detriche, O., Berré, J., Massaut, J., & Vincent, J. L. (1999). The Brussels sedation scale: use of
a simple clinical sedation scale can avoid excessive sedation in patients undergoing mechanical
ventilation in the intensive care unit. British Journal of Anaesthesia, 83(5), 698–701.
4. Parker, W., Estrich, C. G., Abt, E., Carrasco-Labra, A., Waugh, J. B., Conway, A., Lipman, R. D.,
& Araujo, M. W. (2017). Benefits and harms of capnography during procedures involving moderate
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