Published online August 1, 2008
PEDIATRICS Vol. 122 No. 2 August 2008, pp. 293-298 (doi:10.1542/10.1542/peds.2007-2385)

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ARTICLE

Supplemental Oxygen Compromises the Use of Pulse Oximetry for Detection of Apnea and Hypoventilation During Sedation in Simulated Pediatric Patients

Ilan Keidan, MD^a,b, Dietrich Gravenstein, MD^b, Haim Berkenstadt, MD^a,c, Amitai Ziv, MD^c, Itay Shavit, MD^d and Avner Sidi, MD^a,b

^a Department of Anesthesia and Intensive Care
^c Israel Center for Medical Simulation, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
^b Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
^d Department of Pediatric Emergency Medicine, Rambam Medical Center, Haifa, Israel

OBJECTIVE. The goal was to assess the time to recognition of apnea in a simulated pediatric sedation scenario, with and without supplemental oxygen.

METHODS. A pediatric human patient simulator mannequin was used to simulate apnea in a 6-year-old patient who received sedation for resetting of a fractured leg. Thirty pediatricians participating in a credentialing course for sedation were randomly assigned to 2 groups. Those in group 1 (N = 15) used supplemental oxygen, and those in group 2 (N = 15) did not use supplemental oxygen. A third group (N = 10), consisting of anesthesiology residents (postgraduate years 2 and 3 equivalent), performed the scenario with oxygen supplementation, to ensure validity and reliability of the simulation. The time interval from simulated apnea to bag-mask ventilation was recorded. Oxygen saturation and PaCO₂ values were recorded. All recorded variables and measurements were compared between the groups.

RESULTS. The time interval for bag-mask ventilation to occur in group 1 (oxygen supplementation) was significantly longer than that in group 2 (without oxygen supplementation) (173 ± 130 and 83 ± 42 seconds, respectively). The time interval for bag-mask ventilation to occur was shorter in group 3 (anesthesiology residents) (24 ± 6 seconds). PaCO₂ reached a higher level in group 1 (75 ± 26 mmHg), compared with groups 2 and 3 (48 ± 10 and 42 ± 3 mmHg, respectively). There was no significant difference between the groups in oxygen saturation values at the time of clinical detection of apnea (93 ± 5%, 88 ± 5%, and 94 ± 7%, respectively).

CONCLUSIONS. Hypoventilation and apnea are detected more quickly when patients undergoing sedation breathe only air. Supplemental oxygen not only does not prevent oxygen desaturation but also delays the recognition of apnea.

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Key Words: supplemental oxygen • simulation • sedation • pulse oximetry

Abbreviations: SpO₂—pulse oxygen saturation • SaO₂—arterial oxygen saturation • FIO₂—fraction of inspired oxygen • PETCO₂—end-tidal carbon dioxide pressure • PAO₂—partial pressure of oxygen in the alveolae • PIO₂—inspired partial pressure of oxygen

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Accepted Nov 27, 2007.

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This article has been cited by other articles:

				A. E. A. Hemelaar and J. Lemson Patients Under Sedation Should Always Be Monitored by Well-Trained Personnel and Should Be Given Supplemental Oxygen Pediatrics, December 1, 2008; 122(6): 1415 - 1416. [Full Text] [PDF]

				D. Gravenstein, I. Keidan, and A. Sidi Patients Under Sedation Should Always Be Monitored by Well-Trained Personnel and Should Be Given Supplemental Oxygen: In Reply Pediatrics, December 1, 2008; 122(6): 1416 - 1416. [Full Text] [PDF]