TY  - BOOK
AU  - Weintraub, William S
TI  - Inadequacy of Pulse Oximetry in the Catheterization Laboratory. An Exploratory Study Monitoring Respiratory Status Using Arterial Blood Gases during Cardiac Catheterization with Conscious Sedation
SN  - 1878-0938
PY  - 2019///
KW  - *Acidosis, Respiratory/di [Diagnosis]
KW  - *Blood Gas Analysis
KW  - *Cardiac Catheterization
KW  - *Conscious Sedation/ae [Adverse Effects]
KW  - *Hypnotics and Sedatives/ae [Adverse Effects]
KW  - *Monitoring, Ambulatory/mt [Methods]
KW  - *Oximetry
KW  - *Respiration/de [Drug Effects]
KW  - Acidosis, Respiratory/bl [Blood]
KW  - Acidosis, Respiratory/ci [Chemically Induced]
KW  - Acidosis, Respiratory/pp [Physiopathology]
KW  - Aged
KW  - Aged, 80 and over
KW  - Female
KW  - Humans
KW  - Hypnotics and Sedatives/ad [Administration & Dosage]
KW  - Male
KW  - Middle Aged
KW  - Predictive Value of Tests
KW  - Prospective Studies
KW  - Reproducibility of Results
KW  - Risk Factors
KW  - Time Factors
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available in print through MWHC library: 2002 - present
N2  - BACKGROUND: Benzodiazepines and opioids are commonly used for conscious sedation (CS) in cardiac catheterization laboratory (CCL) patients. Both drugs are known to predispose to hypoxemia, apnea and decreased responsiveness to PCO<sub>2</sub>, resulting in decreased arterial pH and PO<sub>2</sub>, as well as increased PCO<sub>2</sub>. We want to determine the effects of CS on arterial blood gas (ABG) in CCL patient, and identify if pulse oximetry monitoring is adequate; CONCLUSION: Significant hypercarbia and acidosis occurred frequently in this small study during CS in patients undergoing cardiac catheterization. Relying on pulse oximetry alone especially with patients on supplemental oxygen may lead to failure in detecting respiratory acidosis in a significant number of patients; Copyright (c) 2018 Elsevier Inc. All rights reserved; METHODS: We enrolled 18 subjects undergoing elective catheterization. Measurement of ABGs at one-minute intervals was done from the moment of arterial access until case end. The results of ABGs were not available to the clinician who administered sedation. Relationships of pH, PCO<sub>2</sub>, PaO<sub>2</sub> and SaO<sub>2</sub> were studied by plotting time series graphs. Significant changes were defined as pH <7.30, SaO<sub>2</sub><90, and PCO<sub>2</sub>>50mmHg; RESULTS: No significant change in pH, PCO<sub>2</sub>, PaO<sub>2</sub> and SaO<sub>2</sub> was noted in 4/18 (22%) subjects. A significant drop in SaO<sub>2</sub> was noted in 4/18 (22%). A significant change in PCO<sub>2</sub> and/or pH was noted in 10/18 (55%) cases. Among the 16 (16/18) subjects receiving supplemental oxygen, 7 (7/18, 39%) had no drop in SaO<sub>2</sub>, but developed respiratory acidosis. At the end of the case, 5/18 (28%) subjects had respiratory acidosis with normal PaO<sub>2</sub>
UR  - https://dx.doi.org/10.1016/j.carrev.2018.07.027
ER  -