Dr.

Supreet Singh Nayyar, AFMC

2012

Capnography

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Monitoring of the concentration or partial pressure of carbon dioxide (CO2) in the respiratory gases As a monitoring tool for use during anaesthesia and intensive care Presented as a graph of expiratory CO2 plotted against time Plot may also show the inspired CO2, which is of interest when rebreathing systems are being used The capnogram is a direct monitor of the inhaled and exhaled concentration or partial pressure of CO2 And an indirect monitor of the CO2 partial pressure in the arterial blood Sudden changes in CO2 elimination during lung or heart surgery usually imply important changes in cardiorespiratory function

Principle
CO2 absorbs infra-red radiation A beam of infra-red light is passed across the gas sample to fall on a sensor The presence of CO2 in the gas leads to a reduction in the amount of light falling on the sensor, which changes the voltage in a circuit The analysis is rapid and accurate, but the presence of nitrous oxide in the gas mix changes the infra-red absorption via the phenomenon of collision broadening

Diagnostic usage
Provides information about o CO2 production o Pulmonary perfusion o Alveolar ventilation o Respiratory patterns o Elimination of CO2 from the anaesthesia breathing circuit and ventilator Shape of the curve is affected by some forms of lung disease e.g. COPD where mixing of gases within the lung is affected

Use in anaesthesia
More effective than clinical judgement alone in the early detection of adverse respiratory events such as hypoventilation, oesophageal intubation and circuit disconnection Thus allowing patient injury to be prevented During procedures done under sedation, capnography provides more useful information than pulse oximetry
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Dr. Supreet Singh Nayyar, AFMC

2012

Capnography and pulse oximetry together could have helped in the prevention of 93% of avoidable anaesthesia mishaps according to an ASA (American Society of Anesthesiologists) study

Use in emergency medical services

Verifying and monitoring the position of an endotracheal tube Indirectly measures cardiac output & so to check effectiveness of CPR Use by nasal monitoring in unintubated patient intimates if intubation might be required

for more topics, visit www.nayyarENT.com

www.nayyarENT.com