{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:45:23Z","timestamp":1787496323393,"version":"build-2736575974"},"reference-count":51,"publisher":"BMJ","issue":"6","funder":[{"DOI":"10.13039\/100004374","name":"Medtronic","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004374","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,3,23]]},"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the effect of capnography monitoring on sedation-related adverse events during procedural sedation and analgesia (PSA) administered for ambulatory surgery relative to visual assessment and pulse oximetry alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>Systematic literature review and random effects meta-analysis of randomised controlled trials (RCTs) reporting sedation-related adverse event incidence when adding capnography to visual assessment and pulse oximetry in patients undergoing PSA during ambulatory surgery in the hospital setting. Searches for eligible studies published between 1 January 1995 and 31 December 2016 (inclusive) were conducted in PubMed, the Cochrane Library and EMBASE without any language constraints. Searches were conducted in January 2017, screening and data extraction were conducted by two independent reviewers, and study quality was assessed using a modified Jadad scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Capnography monitoring relative to visual assessment and pulse oximetry alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Predefined endpoints of interest were desaturation\/hypoxaemia (the primary endpoint), apnoea, aspiration, bradycardia, hypotension, premature procedure termination, respiratory failure, use of assisted\/bag-mask ventilation and death during PSA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The literature search identified 1006 unique articles, of which 13 were ultimately included in the meta-analysis. Addition of capnography to visual assessment and pulse oximetry was associated with a significant reduction in mild (risk ratio (RR) 0.77, 95%\u2009CI 0.67 to 0.89) and severe (RR 0.59, 95%\u2009CI 0.43 to 0.81) desaturation, as well as in the use of assisted ventilation (OR 0.47, 95%\u2009CI 0.23 to 0.95). No significant differences in other endpoints were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Meta-analysis of 13 RCTs published between 2006 and 2016 showed a reduction in respiratory compromise (from respiratory insufficiency to failure) during PSA with the inclusion of capnography monitoring. In particular, use of capnography was associated with less mild and severe oxygen desaturation, which may have helped to avoid the need for assisted ventilation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-013402","type":"journal-article","created":{"date-parts":[[2017,7,17]],"date-time":"2017-07-17T14:51:31Z","timestamp":1500303091000},"page":"e013402","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":101,"title":["Patient safety during procedural sedation using capnography monitoring: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"7","author":[{"given":"Rhodri","family":"Saunders","sequence":"first","affiliation":[{"name":"Coreva Scientific GmbH & Co. KG., Freiburg, Germany"},{"name":"Ossian Health Economics and Communications, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel M R F","family":"Struys","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"},{"name":"Department of Anesthesia, Ghent University, Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9873-7507","authenticated-orcid":false,"given":"Richard F","family":"Pollock","sequence":"additional","affiliation":[{"name":"Ossian Health Economics and Communications, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Mestek","sequence":"additional","affiliation":[{"name":"Minimally Invasive Therapies Group, Medtronic, Boulder, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenifer R","family":"Lightdale","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, UMass Memorial Children\u2019s Medical Center, Westborough, Massachusetts, USA"},{"name":"Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,6,30]]},"reference":[{"key":"2025101811240676000_7.6.e013402.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2006.12.040"},{"key":"2025101811240676000_7.6.e013402.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(04)02016-4"},{"key":"2025101811240676000_7.6.e013402.3","first-page":"260","article-title":"Comparison of two ketamine-propofol dosing regimens for sedation during interventional radiology procedures","volume":"76","author":"Erden","year":"2010","journal-title":"Minerva Anestesiol"},{"key":"2025101811240676000_7.6.e013402.4","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.gie.2008.06.002","article-title":"Sedation and anesthesia in GI endoscopy","volume":"68","author":"Lichtenstein","year":"2008","journal-title":"Gastrointest Endosc"},{"key":"2025101811240676000_7.6.e013402.5","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.02.004"},{"key":"2025101811240676000_7.6.e013402.6","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2005-1709"},{"key":"2025101811240676000_7.6.e013402.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2009.10.027"},{"key":"2025101811240676000_7.6.e013402.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2009.07.020"},{"key":"2025101811240676000_7.6.e013402.9","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1007\/s10620-008-0452-2","article-title":"Risk factors for hypoxemia during ambulatory gastrointestinal endoscopy in ASA I-II patients","volume":"54","author":"Qadeer","year":"2009","journal-title":"Dig Dis Sci"},{"key":"2025101811240676000_7.6.e013402.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.giec.2004.01.008"},{"key":"2025101811240676000_7.6.e013402.11","doi-asserted-by":"publisher","DOI":"10.1213\/01.ANE.0000090145.73834.2F"},{"key":"2025101811240676000_7.6.e013402.12","doi-asserted-by":"publisher","DOI":"10.1213\/01.ANE.0000131964.67524.E7"},{"key":"2025101811240676000_7.6.e013402.13","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1891\/0730-0832.23.4.70","article-title":"What's the latest on carbon dioxide monitoring?","volume":"23","author":"Thomas","year":"2004","journal-title":"Neonatal Netw"},{"key":"2025101811240676000_7.6.e013402.14","doi-asserted-by":"publisher","DOI":"10.1097\/01.pec.0000117922.65522.26"},{"key":"2025101811240676000_7.6.e013402.15","unstructured":"American Society for Gastrointestinal Endoscopy, American College of Gastroenterology, Association TAG. \u00a0Universal adoption of capnography for moderate sedation in adults undergoing upper endoscopy and colonoscopy has not been shown to improve patient safety or clinical outcomes and significantly increases costs for moderate sedation. http:\/\/www.asge.org\/assets\/0\/71542\/71544\/90dc9b63-593d-48a9-bec1-9f0ab3ce946a.pdf (accessed 11 Apr 2016)."},{"key":"2025101811240676000_7.6.e013402.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2010.08.012"},{"key":"2025101811240676000_7.6.e013402.17","doi-asserted-by":"publisher","DOI":"10.1111\/anae.13387"},{"key":"2025101811240676000_7.6.e013402.18","unstructured":"Sourcerer. London, UK: BMJ Publishing Group. https:\/\/sourcerer.pro\/."},{"key":"2025101811240676000_7.6.e013402.19","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(95)00134-4"},{"key":"2025101811240676000_7.6.e013402.20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.326.7400.1167"},{"key":"2025101811240676000_7.6.e013402.21","unstructured":"Review Manager. The Nordic Cochrane Centre. Copenhagen, Denmark: BMJ Publishing Group."},{"key":"2025101811240676000_7.6.e013402.22","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"2025101811240676000_7.6.e013402.23","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(86)90046-2"},{"key":"2025101811240676000_7.6.e013402.24","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/22.4.719"},{"key":"2025101811240676000_7.6.e013402.25","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1038\/ajg.2015.437","article-title":"Capnographic monitoring in routine EGD and colonoscopy with moderate sedation: a prospective, randomized, controlled trial","volume":"111","author":"Mehta","year":"2016","journal-title":"Am J Gastroenterol"},{"key":"2025101811240676000_7.6.e013402.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2009.07.030"},{"key":"2025101811240676000_7.6.e013402.27","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3182a1f0a2"},{"key":"2025101811240676000_7.6.e013402.28","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.136"},{"key":"2025101811240676000_7.6.e013402.29","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1365434"},{"key":"2025101811240676000_7.6.e013402.30","doi-asserted-by":"crossref","first-page":"2336","DOI":"10.12659\/MSM.891023","article-title":"Sidestream capnographic monitoring reduces the incidence of arterial oxygen desaturation during propofol ambulatory anesthesia for surgical abortion","volume":"20","author":"Zongming","year":"2014","journal-title":"Med Sci Monit"},{"key":"2025101811240676000_7.6.e013402.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2014.09.050"},{"key":"2025101811240676000_7.6.e013402.32","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.3109\/00365521.2013.830327","article-title":"The role of capnography in endoscopy patients undergoing nurse-administered propofol sedation: a randomized study","volume":"48","author":"Slagelse","year":"2013","journal-title":"Scand J Gastroenterol"},{"key":"2025101811240676000_7.6.e013402.33","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.dld.2016.08.124","article-title":"Clinical value of the Integrated Pulmonary Index(\u00ae) during sedation for interventional upper GI-endoscopy: A randomized, prospective tri-center study","volume":"49","author":"Riphaus","year":"2017","journal-title":"Dig Liver Dis"},{"key":"2025101811240676000_7.6.e013402.34","first-page":"42","article-title":"Capnographic monitoring of midazolam and propofol sedation during ERCP: a randomized controlled study (EndoBreath Study)","volume":"48","author":"Klare","year":"2016","journal-title":"Endoscopy"},{"key":"2025101811240676000_7.6.e013402.35","doi-asserted-by":"crossref","first-page":"13","DOI":"10.5847\/wjem.j.1920-8642.2016.01.002","article-title":"End-tidal capnometry during emergency department procedural sedation and analgesia: a randomized, controlled study","volume":"7","author":"Campbell","year":"2016","journal-title":"World J Emerg Med"},{"key":"2025101811240676000_7.6.e013402.36","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000258"},{"key":"2025101811240676000_7.6.e013402.37","first-page":"51","article-title":"How to calculate sample size in randomized controlled trial?","volume":"1","author":"Zhong","year":"2009","journal-title":"J Thorac Dis"},{"key":"2025101811240676000_7.6.e013402.38","doi-asserted-by":"crossref","first-page":"E340","DOI":"10.1055\/s-0042-100719","article-title":"Modeling the costs and benefits of capnography monitoring during procedural sedation for gastrointestinal endoscopy","volume":"4","author":"Saunders","year":"2016","journal-title":"Endosc Int Open"},{"key":"2025101811240676000_7.6.e013402.39","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1111\/anae.13378","article-title":"A systematic review of capnography for sedation","volume":"71","author":"Conway","year":"2016","journal-title":"Anaesthesia"},{"key":"2025101811240676000_7.6.e013402.40","doi-asserted-by":"publisher","DOI":"10.2174\/157488709788186021"},{"key":"2025101811240676000_7.6.e013402.41","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/1471-2288-12-44","article-title":"Results from a blind and a non-blind randomised trial run in parallel: experience from the Estonian Postmenopausal Hormone Therapy (EPHT) Trial","volume":"12","author":"Veerus","year":"2012","journal-title":"BMC Med Res Methodol"},{"key":"2025101811240676000_7.6.e013402.42","doi-asserted-by":"publisher","DOI":"10.2174\/157488709788186021"},{"key":"2025101811240676000_7.6.e013402.43","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-010-9366-5"},{"key":"2025101811240676000_7.6.e013402.44","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/1471-2253-14-43","article-title":"Perioperative hypoxemia is common with horizontal positioning during general anesthesia and is associated with major adverse outcomes: a retrospective study of consecutive patients","volume":"14","author":"Dunham","year":"2014","journal-title":"BMC Anesthesiol"},{"key":"2025101811240676000_7.6.e013402.45","doi-asserted-by":"publisher","DOI":"10.1097\/ACO.0b013e32832dba50"},{"key":"2025101811240676000_7.6.e013402.46","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1097\/01.aco.0000236146.46346.fe","article-title":"Closed claims review of anesthesia for procedures outside the operating room","volume":"19","author":"Robbertze","year":"2006","journal-title":"Curr Opin Anaesthesiol"},{"key":"2025101811240676000_7.6.e013402.47","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer059"},{"key":"2025101811240676000_7.6.e013402.48","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer059"},{"key":"2025101811240676000_7.6.e013402.49","doi-asserted-by":"crossref","first-page":"13","DOI":"10.5847\/wjem.j.1920-8642.2016.01.002","article-title":"End-tidal capnometry during emergency department procedural sedation and analgesia: a randomized, controlled study","volume":"7","author":"Campbell","year":"2016","journal-title":"World J Emerg Med"},{"key":"2025101811240676000_7.6.e013402.50","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199708213370806"},{"key":"2025101811240676000_7.6.e013402.51","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2004.02.018"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2016-013402","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T18:24:14Z","timestamp":1760811854000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2016-013402"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,6]]},"references-count":51,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2017,6,30]]},"published-print":{"date-parts":[[2017,6]]}},"alternative-id":["10.1136\/bmjopen-2016-013402"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2016-013402","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,6]]}}}