14 de janeiro de 2013

Artigo recomendado: Capnography Outside the Operating Rooms

Bhavani Shankar Kodali

Anesthesiology 2013; 118:192–201, Kodali, BS

Historically, anesthesiologists seem to be the forerunners in implementing tools and standards for safety in the medical fraternity. In the United States, since 1985, there has been a dramatic decrease in the malpractice insurance premiums of anesthesiologists. Such a decrease has not been seen in other medical or surgical specialties over this time frame. Thanks to the foresight of the American Society of Anesthesiologists (ASA), Anesthesia Patient Safety Foundation (APSF), Association of Anaesthetists of Great Britain and Ireland (AAGBI), and the Association of Anesthesiologists in Holland, capnography was embraced and incorporated into the standards of monitoring during anesthesia to enhance patient safety. Currently, anesthesiologists in many developing countries follow these recommendations (India, Government of Andhra Pradesh Order, AST/775/F25/dated September 2011. 
Capnography is mandatory for laparoscopic surgeries for reimbursement). Although capnography has become an integral part of anesthesia care in operating rooms for more than 25 yr, its value has been limited to these situations and is not well appreciated beyond these confinements. It is not uncommon in our practice to observe an intubated and ventilated patient, originally monitored with capnography in the operating room, but then transported to the intensive care unit (ICU) without capnography. It is even more surprising that many ICUs do not have capnography either to confirm endotracheal intubation or to continually monitor ventilation. As anesthesiologists, we use capnography to monitor sedation in the operating room because we appreciate that the line between consciousness and unconsciousness is very thin, and the patient can drift from one state to another. However, in many institutions, capnography is not used to monitor ventilation during sedation for procedures performed particularly by nonanesthesiologists outside of the operating rooms. 
One of the obvious reasons seems to be a lack of a single society overseeing the safety of outside-the-operating-room procedures the way ASA and AAGBI do in the operating room. Nonetheless, in the last 2 yr there has been a surge in understanding and recognizing the value of capnography outside of the operating rooms.1,2 This “Clinical Concepts and Commentary” will summarize physiology and clinical interpretation of capnography and update the current status of capnography outside of the operating rooms, including public and media awareness, and suggest probable future directions.

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