Value of Capnography During Nurse Administered Propofol Sedation (NAPS)
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Purpose
Propofol is widely used by anaesthesiologists for deep sedation and general anaesthesia. During recent years nurses trained in the use of low dose Propofol sedation (NAPS) during endoscopy have been introduced. The method has been implemented at the endoscopic unit at Gentofte hospital since 2008(1). Propofol has a respiratory depressive effect which may result in depressed oxygen saturation in the blood (hypoxia). Due to a short acting half life this is prevented in the majority of cases. However, in spite of this, hypoxia is experienced in 4,4% of patients receiving propofol during endoscopy at Gentofte Hospital (unpublished data). It is well known that hypoxia constitutes a late expression of reduced oxygen tension in peripheral tissues. Whether the addition of capnography to standard monitoring during NAPS may be of benefit is widely unknown. The aim of this study is to examine whether the additional use of capnography to standard monitoring during endoscopy may improve patient safety in patients undergoing low dose Propofol sedation by reducing the number, duration and level of hypoxic events. The trial is a randomized clinical prospective case-control study.
| Condition | Intervention |
|---|---|
|
Hypoxia |
Device: Capnography (Phillips MP20 monitor) |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Prevention |
| Official Title: | The Role of Capnography in Endoscopy Patients Undergoing Nurse Administered Propofol Sedation (NAPS): A Randomized Study |
- The number of hypoxic events [ Time Frame: The sum of events registered during procedures (procedure duration is, depending on the type, 3 to 90 minutes) ] [ Designated as safety issue: Yes ]If the addition of capnography to standard monitoring can reduce the number of hypoxic events in patients undergoing endscopy with NAPS. A hypoxic event is defined as an observed oxygen saturation of less than 92% . Data is collected by a computer with intervals of 12 sec as the smallest possible.
- Actions taken against respiratory insufficiency [ Time Frame: Registered during procedure(procedure duration is, depending on the type, 3 to 90 minutes) ] [ Designated as safety issue: Yes ]Whether more or less actions are taken against respiratory insufficiency with or without capnography in patients undergoing endoscopy with NAPS.
- The duration of hypoxia [ Time Frame: The sum of time with hypoxia registered during procedures (procedure duration is, depending on the type, 3 to 90 minutes) ] [ Designated as safety issue: Yes ]The duration of hypoxia is measured as the sum of registrations(each registration represents 12 seconds) with an oxygen saturation of less than 92 percent. Data is collected by a computer with intervals of 12 sec as the smallest possible.
- The level of hypoxia [ Time Frame: The sum of events registered at each level during procedures (procedure duration is, depending on the type, 3 to 90 minutes) ] [ Designated as safety issue: Yes ]
Saturation is registered every 12 seconds into a computer. Hypoxia (saturation <92%) was divided into three levels of hypoxia: 1. <92% - 90%,2. <90% - 88%, 3. <88%.
And the number of events in each group was summed up.
| Enrollment: | 591 |
| Study Start Date: | September 2010 |
| Study Completion Date: | March 2011 |
| Primary Completion Date: | February 2011 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: With Capnograpy
Intervention group with the addition of capnography to standard monitoring (non-invasive blood pressure, pulse, pulse oximetry, clinical observation of respiration, electrocardiography (ECG) and respiratory frequency measured by the ECG)
|
Device: Capnography (Phillips MP20 monitor)
In the intervention group the NAPS nurse observed possible hypoxia and changes in capnography curves/values during the procedure and was instructed to decrease propofol and take actions against insufficient ventilation* if etCO2 ≥ 7kPa or ≤ 2 kPa for ≥ 1 minute, if respiratory frequency ≤ 8 or a loss of curve shape was registered. *Suction, increase oxygen supply, tongue holder or nasal airway, bag-mask ventilation,paged anaesthesia Discontinued procedures Other Names:
|
|
No Intervention: No Capnography
Control group without the addition of capnography to standard monitoring (non-invasive blood pressure, pulse, pulse oximetry, clinical observation of respiration, electrocardiography (ECG) and respiratory frequency measured by the ECG)
|
Eligibility| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- aged 18 or above
- compliant with the criteria of NAPS.
Exclusion Criteria:
- no signed written consent obtained
- American Society of Anaesthesiologists (ASA) physical status classification > 3
- sleep apnoea
- allergy against soy, eggs and peanuts
- body Mass Index (BMI) > 35 kg/m2
- mallampati Score ≥ 4
- acute gastrointestinal bleeding
- subileus
- ventricular retention
- severe COLD ((30% ≤ FEV1 <50%)
- failed data collection
Contacts and Locations| Denmark | |
| Gentofte University Hospital | |
| Hellerup, Denmark, 2900 | |
| Study Director: | Peter Vilmann, MD, Prof. | Herlev and Gentofte University Hospital, Denmark |
| Principal Investigator: | Charlotte Slagelse, Med. student | Gentofte University Hospital, Denmark |
More Information
No publications provided
| Responsible Party: | Charlotte Slagelse, Medical Student, University Hospital, Gentofte, Copenhagen |
| ClinicalTrials.gov Identifier: | NCT01507623 History of Changes |
| Other Study ID Numbers: | NAPS_CAPNOGRAPHY1 |
| Study First Received: | November 24, 2011 |
| Last Updated: | January 10, 2012 |
| Health Authority: | Denmark: The Danish National Committee on Biomedical Research Ethics |
Keywords provided by University Hospital, Gentofte, Copenhagen:
|
NAPS Hypoxia Propofol |
capnography endoscopy Sedation |
Additional relevant MeSH terms:
|
Anoxia Signs and Symptoms, Respiratory Signs and Symptoms Propofol Anesthetics, Intravenous Anesthetics, General Anesthetics |
Central Nervous System Depressants Physiological Effects of Drugs Pharmacologic Actions Central Nervous System Agents Therapeutic Uses Hypnotics and Sedatives |
ClinicalTrials.gov processed this record on June 17, 2013