What Factors Are Associated With Clinician’s Choice to Use Capnography in the Office-Based Ambulatory Anesthesia Setting?
Continuous display of the measured end tidal volume CO2 (PETCO2) is a sensitive and accurate method for detecting apnea and airway obstruction in the setting of office-based ambulatory anesthesia.[1] Respiratory monitoring during office-based ambulatory anesthesia, however, varies from practice to practice.[2]The purpose of this study was to identify associations between capnography use and practice patterns among clinicians who provide sedation in the office-based ambulatory setting. The investigators hypothesized that there was a set composed of one or more variables associated with a clinician’s choice to use capnography.
Materials and Methods:
Study design/Sample: To address the research purpose, we used data collected from the “AAOMS Anesthesia and Third Molar Extraction Benchmark Study.”[3]The study was designed as a prospective cohort study and enrolled a sample composed of randomly selected American private practicing oral and maxillofacial surgeons (OMSs). Participants were asked to enter data on all eligible patients they treated during the one-month time period when they were enrolled in the study.
Study variables: The predictor variables were composed of a heterogeneous set of variable that were grouped into the following categories: surgeon demographics, patient demographics, anesthesia provider, level of anesthesia (moderate sedation (MS), deep sedation and general anesthesia DS/GA), anesthesia risk factors (Mallampati class, ASA status, tobacco or alcohol use, chronic disease), procedure types (pathology, dentoalveolar, other), monitoring methods (pulse oximetry, precordial stethoscope, pretracheal stethoscope, ECG, chest movement, EEG, temperature, others), medications (local anesthetic , premedication, narcotic, benzodiazepines, vapor agents, other), and patient-centered outcomes (anxiety, remember pain, remember discharge instructions, remember nothing, satisfaction, recommend technique, future anxiety).
The outcome variable was capnography use during MS or DS/GA coded as yes or no.
Methods of data analysis
Appropriate descriptive and bivariate statistics evaluated the association between the predictor variables and outcome variable. In this study statistical significance was set at ≤ 0.05
Results
The professional sample was composed of 95 OMSs with a mean age of 50.4 (SD=10.1) and 91.6 % were male. OMS-specific demographic variables were not statistically associated with capnography use (p-values were >0.075).
The patient sample was composed of 3495 subjects with a mean age of 30.56, 43.5% were male and 5.6% percent used capnography. There were no demographic variables associated with capnography.
Categorical variables statistically associated (p<0.05) with capnography use were: procedure type, narcotic administration, not using ketamine, not using methohexital, using propofol, using sevoflurane, not using precordial stethoscope, using ECG, no other monitoring, remembering discharge instructions and remembering nothing about the procedure.
Continuous variables statistically associated (p<0.05) with capnography use were: mean age, alcoholic drinks per day, anesthesia time, recovery time, number of monitoring methods, and total number of medications administered to patients.
Conclusions
The results of this study confirmed the hypothesis that numerous factors were associated with the clinician’s choice to use capnography.
References
1) Anderson JA, Clark PJ, Kafer ER. Use of capnography and transcutaneous oxygen monitoring during outpatient general anesthesia for oral surgery. J Oral Maxillofac Surg. 1987; 45:3–10.
2) Farish SE, Garcia PS (2013) Capnography Primer for Oral and Maxillofacial Surgery: Review and Technical Considerations. J Anesthe Clinic Res. 2013 Mar 18;4(3): 295.
3) Dodson TB. 2011-2012 AAOMS Anesthesia-third molar outcome study. In Anesthesia and Third Molar Extraction Benchmark Statistics,2012 Annual Meeting of the American Association of Oral and Maxillofacial Surgeons, San Diego, CA.
This study was supported in part by AAOMS Anesthesia and Third Molar Extraction Outcome Studies (PI – Dodson) and University of Washington Department of Oral and Maxillofacial Surgery’s Research and Education Fund.