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The Importance of Capnography in Sedation: A Case for Universal Adoption

By: Dr. Travis Coulter

Published: 7/10/2024

I get asked quite a bit why I always suggest capnography to every provider regardless of the level or type of sedation they perform. It’s a valid question. Some states still don’t require capnography for even IV sedation much less minimal sedation. So, if it’s not a state regulation, why use it? Me personally, I consider state regulation requirements to be a minimum when it comes to patient monitoring and I am not going to limit the quality of care I offer to patients just because a state regulation says I don’t need to. I get it. That’s just my opinion. Here’s some more information for you to consider.

We are all aware how crucial capnography has become as an essential tool for monitoring respiratory status during general anesthesia. This noninvasive technology provides real-time data on a patient's ventilatory status, enabling healthcare providers to detect and respond to respiratory issues promptly. But what about moderate sedation or even minimal sedation?

Real-time Monitoring for Early Detection

Capnography offers immediate insights into a patient's respiratory status, crucial for early detection of hypoventilation and apnea. According to the British Columbia Medical Journal, using capnography during procedures has been shown to reduce the incidence of hypoxia significantly. For example, in a study by Qadeer et al., the use of capnography reduced the rate of hypoxia from 46% to 69% and severe hypoxia from 15% to 31% in patients undergoing procedural sedation. This early detection capability allows for timely intervention, preventing severe complications.

Improved Patient Outcomes

Research underscores the impact of capnography on patient outcomes. A systematic review and meta-analysis published in BMJ Open highlighted that capnography monitoring during procedural sedation reduced the risks of severe hypoxia and other adverse events. By providing continuous monitoring, capnography ensures that any deviations in respiratory status are quickly identified and addressed, thereby enhancing patient safety and outcomes.

Quantitative and Noninvasive Monitoring

Capnography is valued for its noninvasive nature and ability to provide quantitative data. As noted in an overview by Respiratory Therapy Zone, capnography not only offers a continuous readout of CO2 levels but also tracks changes over time, which is critical for assessing the effectiveness of interventions. This method is comfortable for patients and can be used for extended periods without causing discomfort, making it an ideal tool for sedation monitoring.


The evidence supporting the use of capnography in all levels of sedation is compelling. Its ability to provide real-time, noninvasive, and quantitative data significantly enhances patient safety and improves clinical outcomes. Sure, having capnography has a cost to get into it, but the immediate value added to each case in supplying providers with near immediate data regarding the airway and physiologic status of that provider’s patient far exceeds the cost.

Given these benefits, I believe it is a worthy investment to incorporate capnography into EVERY case, regardless of the level of sedation. This approach will ensure that we are providing the highest standard of care and maximizing patient safety. This is one of many reasons that we at Xchart make it possible for providers to have automatic vitals recording so you can get the benefits of capnography with adding little to no work for recording it. Once you start using capnography you will never go back!

If you’d like to learn some more about reading the capnography waveform see this article discussing just that.

Stay paperless my friends!

Travis Coulter DDS Co-founder

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