Capnography During Procedural Sedation and Analgesia with Intramuscular Ketamine in Paediatric Patients

Introduction: Capnography is a proven effective tool for procedural sedation and analgesia (PSA); however it is hardly available in developing countries like Iran. This study aimed to discover the frequency of hypoventilation in paediatric patients who received intramuscular (IM) ketamine and evaluate the relationship between end-tidal carbon dioxide (ETCO2 ) changes and other vital signs. Methods: This was a cross-sectional study conducted in 2019. Paediatric patients (under 14 years old) who underwent PSA with 5 mg/kg of ketamine given IM participated in this study. ETCO2 was monitored by the mainstream CO2 sensor. Hypoventilation was defined as ETCO2 variation >10 mmHg from the baseline. Patients ETCO2 , oxygen saturation (SPO2 ), pulse rate (PR), respiratory rate (RR) and blood pressure (BP) were continuously monitored and recorded. The specificity and sensitivity of SPO2 for detecting 10 mmHg change in the ETCO2 level were calculated. In addition, the PR, RR and BP were grouped based on patients’ age (1-3 and 3-6 years) and compared between patients who had hypoventilation and others. Results: A total of 121 patients were enrolled in the study. The mean ± standard deviation of age was 2.89±1.48 years (minimum =1.2 and maximum =5.8 years). Nineteen (15.7%) patients had >10 mmHg changes in the ETCO2 level. In both age groups, PR and RR had a significant difference between patients with hypoventilation and other patients (p=0.001 in 1-3 years and 0.003 in 3-6 years). Conclusion: Hypoventilation was frequent among paediatric patients who received IM ketamine; however, it was minimal and required simple airway manoeuvres. Pulse oximetry was not accurate to detect this small amount of hypoventilation. Thus, cap

Pediyatrik Hastalarda İntramüsküler Ketamin ile Prosedürel Sedasyon ve Analjezi Sırasında Uygulanan Kapnografi

Giriş: Kapnografi, prosedürel sedasyon ve analjezi (PSA) için kanıtlanmış etkili bir araçtır; ancak İran gibi gelişmekte olan ülkelerde neredeyse hiç bulunmamaktadır. Bu çalışma, intramüsküler (İM) ketamin alan pediyatrik hastalarda hipoventilasyon sıklığını incelemeyi ve soluk sonu karbondioksit (ETCO2 ) değişiklikleri ile diğer yaşamsal belirtiler arasındaki ilişkiyi değerlendirmeyi amaçladı. Yöntemler: Bu çalışma, 2019 yılında yapılan kesitsel bir çalışmadır. Bu çalışmaya İM 5 mg/kg ketamin ile PSA uygulanan pediyatrik hastalar (14 yaş altı) katıldı. ETCO2 , ana CO2 sensörü ile izlendi. Hipoventilasyon, varyasyonu başlangıca göre ETCO2 >10 mmHg olarak tanımlandı. Hastaların ETCO2 , oksijen satürasyonu (SPO2),nabız hızı (PR), solunum hızı (RR) ve kan basıncı (BP) sürekli izlenerek kaydedildi. ETCO2 seviyesindeki 10 mmHg değişimi tespit etmek için SPO2 ’nin özgüllüğü ve duyarlılığı hesaplandı. Ek olarak, PR, RR ve BP hastaların yaşına (1-3 ve 3-6 yaş) göre gruplandırıldı ve hipoventilasyon olan hastalar ve diğerleri arasında karşılaştırıldı. Bulgular: Çalışmaya toplam 121 hasta kaydedildi. Yaşın ortalama ± standart sapması 2,89±1,48 yıldı (minimum =1,2 ve maksimum =5,8 yıl). On dokuz (%15,7) hastada ETCO2 seviyesinde >10 mmHg değişiklik vardı. Her iki yaş grubunda da PR ve RR açısından hipoventilasyonlu hastalar ile diğer hastalar arasında anlamlı bir fark vardı (1-3 yılda p=0,001 ve 3-6 yılda p=0,003). Sonuç: İM ketamin alan pediyatrik hastalarda hipoventilasyon sıktı; ancak minimaldi ve basit hava yolu manevraları gerektirdi. Nabız oksimetresi, bu küçük miktardaki hipoventilasyonu saptamak için uygun değildi. Bundan dolayı kapnografi, ketamin PSA sırasında daha iyi izleme sağlayacaktır.

Kaynakça

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