Patient Education and Consent

Explain to patients that you are monitoring their breathing and that this should not have any effect on them. They may simply breathe normally.

Equipment

Equipment employed in end-tidal capnography includes the following:

End-tidal capnometer (fixed or portable)
Mainstream or sidestream sampling (see End-Tidal CO2 Detectors)
Nasal cannula or mask adaptors (nonintubated patients)

The end-tidal capnometer must be prepared, calibrated, and tested prior to use. (See the image below).

Esophageal intubation.

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Patient Preparation

The patient should be in a position that both facilitates airway patency and allows adequate exposure for the procedure being performed. Often, the anesthesia provider and the surgeon discuss which technique and position will minimize risks to the patient prior to the procedure. Ideally, if endotracheal intubation is indicated, the patient is placed in a supine position for induction of general anesthesia and airway management.

Technique

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[Guideline] Committee on Standards and Practice Parameters. Standards for basic anesthetic monitoring. American Society of Anesthesiologists. Available at http://www.asahq.org/quality-and-practice-management/standards-guidelines-and-related-resources/standards-for-basic-anesthetic-monitoring. December 13, 2020; Accessed: January 3, 2023.
[Guideline] Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Anesthesiology. 2018 Mar. 128 (3):437-479. [QxMD MEDLINE Link]. [Full Text].
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Media Gallery

Normal breathing.
Normal mechanical ventilation.
Hyperventilation.
Hypoventilation.
Bronchospasm.
Exhausted carbon dioxide absorbant.
Esophageal intubation.
Capnogram breathing. Courtesy of Pedro Tanaka, MD.
Curare cleft.

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Author

Robert Thomas Arrigo, MD, MS Resident Physician, Department of Anesthesiology, Stanford University School of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Arjun M Desai, MD Resident Physician, Department of Anesthesiology, Stanford University Hospital and Clinics

Disclosure: Nothing to disclose.

Pedro P Tanaka, MD, PhD, MACM Clinical Professor, Associate Program Director for Anesthesia Residency, Fellowship Director, Advanced Training in Medical Education, Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine

Pedro P Tanaka, MD, PhD, MACM is a member of the following medical societies: American Society of Anesthesiologists, Brazilian Society of Anesthesiology, California Society of Anesthesiologists, Latin American Society of Regional Anesthesia, Paranaense Society of Anesthesiology

Disclosure: Nothing to disclose.

Alex Macario, MD, MBA Professor of Anesthesia, Program Director, Anesthesia Residency, Professor (Courtesy), Department of Health Research and Policy, Stanford University School of Medicine

Alex Macario, MD, MBA is a member of the following medical societies: American Medical Association, American Society of Anesthesiologists, California Medical Association, International Anesthesia Research Society

Disclosure: Received consulting fee for: Merck.

Chief Editor

Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women's Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Christopher D Press, MD Resident Physician, Department of Anesthesiology, Stanford University School of Medicine

Christopher D Press, MD is a member of the following medical societies: American Medical Association, American Society of Anesthesiologists

Disclosure: Nothing to disclose.

Acknowledgements

Acknowledgments

Special thanks to Cheri Touchard and the Tulane Center for Advanced Medical Simulation.

End-Tidal Capnography Periprocedural Care

Patient Education and Consent

Equipment

Patient Preparation

References

Tables

Contributor Information and Disclosures

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