No abstract available.
Capnography*

No abstract available.
Capnography* ; Humans

No abstract available.
Capnography ; Humans

Unidirectional valve malfunction causes re-breathing of expired gas during anesthesia. Capnography is a useful method for monitoring the integrity of anesthetic equipment such as the unidirectional valves in a circular system. We report, here a case in which the capnography did not sound any rebreathing alarm, but the capnogram showed a prolonged plateau, an apparently short inspiratory period and a gradually sloping descending limb that stopped just short of baseline. As a result, capnography helped to identify an inspiratory unidirectional valve malfunction during the course of anesthesia. This study emphasizes the need to analyze the capnogram during every procedure involving anesthesia, in addition to preoperative checking of the Unidirectional valve.
Anesthesia ; Capnography ; Extremities

Malfunction of the unidirectional valve in a breathing circuit system may cause hypercapnia from the rebreathing of expired gas, ventilation failure, and barotrauma. Capnography is a useful method for monitoring the integrity of the unidirectional valve. We experienced two cases of malfunction of a unidirectional valve which caused leakage and reverse flow, diagnosed early as a change of the capnographic waveform. One case was caused by expiratory unidirectional valve breakage. The other was caused by an incorrectly-assembled inspiratory unidirectional valve.
Barotrauma ; Capnography ; Hypercapnia ; Respiration ; Ventilation

With the rapid development of diagnostic and therapeutic procedures performed outside the operating room (OR), the need for appropriate sedation care has emerged in importance to ensure the safety and comfort of patients and clinicians. The preparation and administration of sedatives and sedation care outside the OR require careful attention, proper monitoring systems, and clinically useful sedation guidelines. This literature review addresses proper monitoring and selection of sedatives for diagnostic and interventional procedures outside the OR. As the depth of sedation increases, respiratory depression and cardiovascular suppression become serious, necessitating careful surveillance using appropriate monitoring equipment.
Capnography ; Dexmedetomidine ; Humans ; Hypnotics and Sedatives ; Operating Rooms ; Respiratory Insufficiency

BACKGROUND: The capnographic curve indices, such as the slope of expiratory upstroke or alveolar plateau quantified by using the waveform of the capnogram, are correlated with obstructive airway disease. Some studies also have shown good correlations between these indices and FEV1 or PEFR, which are objective measurements for the classification of severity in asthma. We performed this study to suggest the feasibility of using expiratory capnography for monitoring asthmatic subjects in emergency departments(ED). METHODS: One hundred adult patients diagnosed with bronchial asthma were enrolled in this study. Using main-stream-type capnography(ULTRA CAP, Nellcor, USA), the angles alpha and Q on the capnographic trace were measured; then, the slope of expiratory upstroke(S1) was calculated. Patients were allocated by using the classifying severity of asthma exacerbation of the National Asthma Education and Prevention Program(NAEPP), and the capnographic indices were compared. A measured values of the angle Q for all patients were classified into 3 categories by the percentile; then, the correlation between the category of the angle Q and the classifying severity was analyzed. RESULTS: There were significant differences in the angle Q according to the severity of the asthma. Also, there was a significant correlation between the category of the angle Q and the classifying severity of asthma exacerbation. CONCLUSION: This study suggests that expiratory capnography would be a useful monitoring technique for adult asthmatic patients and for the triage of asthmatic patients in an ED setting, provided the capnographic indices are measured as rapidly as possible. Therefore, we look forward to the development of a computerized analysis program for easy measurement and quantification of capnographic indices.
Adult ; Asthma* ; Capnography ; Classification ; Education ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Peak Expiratory Flow Rate ; Triage

BACKGROUND: Maintenance of adequate concentration of carbon dioxide during hypothermic cardiopulmonary bypass is important in order to improve tissue perfusion by maintaining vasodilatation. This study evaluated the usefulness of the analysis of gas sampled from the exhaust port of a membrane oxygenator in the estimation of carbon dioxide tension in arterial blood (PaCO2). METHODS: One hundred sixty four arterial blood gases were drawn from 45 adult and 30 pediatric cardiac surgical patients undergoing hypothermic cardiopulmonary bypass. Carbon dioxide tensions were measured in the membrane oxygenator exhaust gas (swept gas; PswCO2) using a capnography and in arterial blood using intermittent gas analysis. We compared the PswCO2 with temperature-uncorrected (alpha-stat) and -corrected (pH-stat) PaCO2 during cardiopulmoary bypass. RESULTS: The mean PaCO2 measured with alpha-stat and pH-stat, and PswCO2 obtained in adult patients during hypothermic cardiopulmonary bypass were 29.8 +/- 4.9, 19.5 +/- 4.1 and 22.3 +/- 4.2 mmHg, respectively. In pediatric patients, alpha-stat PaCO2, pH-stat PaCO2 and PswCO2 were 39.7 +/- 7.7, 24.7 +/- 6.2 and 20.3 +/- 6.0 mmHg, respectively. There was a significant positive correlation between PswCO2 and alpha-stat PaCO2 (adult patients: slope = 0.49, r = 0.64, P < 0.001; pediatric patients: slope = 0.53, r = 0.68, P < 0.001) and pH-stat PaCO2 (adult patients: slope = 0.85, r = 0.81, P < 0.001; pediatric patients: slope = 0.73, r = 0.73, P < 0.001). On comparison of subsequent measurements, 3.8% (adult patients) and 11.4% (pediatric patients) of changes in PaCO2 and PswCO2 were in opposite direction. CONCLUSIONS: Our results indicate that in adult and pediatric patients undergoing hypothermic cardiopulmonary bypass PswCO2 can be an indicator of changes in trend of PaCO2.
Adult ; Capnography ; Carbon Dioxide* ; Carbon* ; Cardiopulmonary Bypass* ; Gases ; Humans ; Oxygen* ; Oxygenators* ; Oxygenators, Membrane ; Perfusion ; Vasodilation

PURPOSE: The aim of this study was to assess the accuracy and timeliness of using tracheal ultrasound for examination of endotracheal tube placement in cardiac arrest patients. METHODS: This was a prospective, observational study, conducted at the emergency department of a university teaching hospital. Patients underwent emergency intubation due to cardiac arrest. Airway ultrasonography was performed during emergency intubation with the transducer placed transversely at the trachea over the suprasternal notch. Quantitative waveform capnography was used as the criterion standard for confirmation of tracheal intubation. The main outcome was the timeliness between airway ultrasonography and capnography. RESULTS: A total of 16 patients and 19 intubations were included in the analysis. The endotracheal tube was placed in the trachea in 16 intubations and in the esophagus in three intubations. The overall sensitivity and specificity of ultrasound for confirmation of tracheal intubation was 100%, respectively. The capnography application time after intubation was 17.5(10.0~32.5) seconds. The capnograpny confirmation time after application was 30(10~120) seconds. The ultrasound confirmation time for endotracheal tube placement after application was 5(4~5) seconds. CONCLUSION: When patients were in a low pulmonary blood flow state, such as cardiac arrest, capnography confirmation of endotracheal tube placement was not rapid and needed a lot of times. Ultrasound confirmation was very rapid and accurate, and was not affected by pulmonary blood flow. Ultrasound confirmation of endotracheal tube placement is more useful in the emergency department.
Capnography ; Emergencies ; Esophagus ; Heart Arrest ; Hospitals, Teaching ; Humans ; Intubation ; Prospective Studies ; Sensitivity and Specificity ; Trachea ; Transducers

PURPOSE: The purpose of this study was to determine whether continuous capnography monitoring detects adverse respiratory and airway events earlier than pulse oximetry and the clinical exam can during intramuscular ketamine for procedural sedation in children. METHODS: This study was a prospective observational study conducted from April 2009 to March 2010 in an urban Korean teaching hospital. Pediatric patients who needed procedural sedation for primary closure were enrolled. After patients received intramuscular ketamine, they were monitored using clinical ventilation assessment, pulse oximetry and capnography. Adverse respiratory and airway events were recorded RESULTS: A total of 91 patients were enrolled. Of the 91 patients, 16 (17%) had adverse respiratory events; 5 had hypoxia. Capnography was 100% sensitive for predicting hypoxia and apnea. CONCLUSION: When intramuscular ketamine is administered for procedural sedation in children, capnography allows early detection of adverse respiratory events.
Anoxia ; Apnea ; Capnography ; Child ; Conscious Sedation ; Hospitals, Teaching ; Humans ; Ketamine ; Oximetry ; Prospective Studies ; Ventilation