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A85
October 13, 2007 9:00 AM - 11:00 AM Room Hall D, Area C, |
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| An Evaluation of a New Combined SpO2 and PtcCO2 Monitor (TOSCA) during Monitored Anesthesia Care | ||||||||||||||||||||||||||||
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Nitin K. Shah, M.D., Shermeen Vakharia, M.D., Helen Kim, M.D., Laverne Estanol, R.R.T. Anesthesiology, UC Irvine, Medical Center, Long Beach VAHS, Orange, California |
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Introduction TOSCA is a FDA approved device that provides continuous readings of transcutaneous carbon dioxide (PtcCO2), oxygen (SpO2), and pulse rate, non-invasively. Pulse oximetry certainly gives reliable information about oxygenation, and end-tidal CO2 gives reliable information about CO2 in intubated patients. Presently, we do not have any reliable CO2 monitor for non-intubated patients. With supplemental oxygen, SpO2 will give a late warning of oversedation in patients undergoing MAC. While hypoventilation from oversedation leading to CO2 retention may be an early sign of oversedation during MAC. However, end-tidal CO2 during MAC is not reliable. PtcCO2 has been tried and works well in neonates but has not been found to be accurate in adults. TOSCA is a new PtcCO2 (ear sensor) monitor that heats up the tissue to 42 degrees C and gives reliable CO2 values. It can be used for up to only 12 hours at one site as it can heat up the underlying tissue if left for longer than 12 hours. Preliminary studies show that PtcCO2 obtained via TOSCA is comparable to blood gas analysis1,2. We undertook the following study to evaluate the usefulness of TOSCA in patients receiving Monitored Anesthesia Care (MAC). Methods Following IRB approval of the protocol and obtaining informed consent, 38 patients undergoing MAC were studied. ASA standard monitors were used to monitor the patients. Patients were given oxygen via face masks and their end-tidal CO2 were monitored through the mask, employing a 16 gauze canula attached to the monitor line. The TOSCA sensor was placed randomly on either earlobe of the patients. Patients sedation levels were assessed using modified Ramsay Sedation Scale (mRSS) from 1 being awake, to 6 being unresponsive. Data were collected every 5 minutes for end-tidal CO2 and PtcCO2. The monitor was left for between 25 minutes to 330 minutes. We compared respiratory rate, PtcCO2 and end-tidal CO2 with mRSS. Paired t-tests, using the Excel program, was used for statistical comparison. P<0.05 was considered statistically significant. Results TOSCA performed reliably on all 38 patients. Oxygen saturation and pulse rate remained stable thoughout the study. The table shows our results. Discussion PtcCO2 correlated better with mRSS than end-tidal CO2 and respiratory rate. It appears from this ongoing study that PtcCO2 may become a tool available to clinicians to titrate sedation while patients are receiving MAC with oxygen supplements. References 1. Dullenkopf A, et al. Evaluation of a new combined SpO2/PtcCO2 sensor in anesthetized paediatric patients. Paediatric Anesthesia 2003;13(9):777-784. 2. Rohling R, et al. Clinical investigation of a new combined pulse oximetry and carbon diaoxide tension sensor in adult anesthesia. Journal of Clinical Monitoring and Computing 1999;15:23-27.[table1] Anesthesiology 2007; 107: A85 |
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