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      Therapeutics and Clinical Risk Management (submit here)

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      The addition of capnography to standard monitoring reduces hypoxemic events during gastrointestinal endoscopic sedation: a systematic review and meta-analysis


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          The use of capnography monitoring devices has been shown to lower the rates of hypoxemia via early detection of respiratory depression, and facilitate more accurate titration of sedatives during procedures. The aim of the current meta-analysis was to compare the incidence of hypoxemia associated with standard monitoring alone during gastrointestinal endoscopy to that associated with standard monitoring with the addition of capnography.


          The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials scientific databases were searched to identify relevant studies. We performed a meta-analysis of randomized controlled trials undertaken up to January 2018 that met our predefined inclusion criteria. The study outcome measures were incidence of hypoxemia, severe hypoxemia, apnea, the use of assisted ventilation, the use of supplemental oxygen, and change in vital signs.


          We included nine trials assessing a total of 3,088 patients who underwent gastrointestinal procedural sedation. Meta-analysis of study outcome revealed that capnography significantly reduced the incidence of hypoxemia (odds ratio 0.61, 95% CI 0.49–0.77) and severe hypoxemia (odds ratio 0.53, 95% CI 0.35–0.81). However, there were no significant differences in other outcomes including incidence of apnea, assisted ventilation, supplemental oxygen, and changes in vital signs. Early procedure termination and patient satisfaction-related outcomes did not differ significantly in the capnography group and the standard monitoring group.


          This study indicates that capnography monitoring is an important addition with regard to the detection of hypoxemia during gastrointestinal procedural sedation, and should be considered in routine monitoring during gastrointestinal endoscopy.

          Most cited references24

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          Practice guidelines for sedation and analgesia by non-anesthesiologists.

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            Sedation and anesthesia in GI endoscopy.

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              Quality control in systematic reviews and meta-analyses.

              Systematic reviews and meta-analyses are being submitted to, and being published by biomedical journals with increasing frequency. In order to maintain the utility of such publications and avoid misguidance it is important that these studies are conducted to a high standard. This article aims to provide guidance both for those researchers undertaking and reporting such studies and for the readers of such articles. Details of a suggested method for conducting a systematic review are given, including methods for literature searches, data abstraction and data extraction followed by a brief overview of common methods used for meta-analyses and the interpretation of the results of meta-analysis.

                Author and article information

                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                06 September 2018
                : 14
                : 1605-1614
                [1 ]Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
                [2 ]Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
                [3 ]Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea, yschoi@ 123456yuhs.ac
                Author notes
                Correspondence: Yong Seon Choi, Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea, Tel +82 2 2228 2412, Fax +82 2 2227 7897, Email yschoi@ 123456yuhs.ac
                © 2018 Kim et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Original Research

                endoscopy,additional monitoring,hypoxemia,apnea
                endoscopy, additional monitoring, hypoxemia, apnea


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