Anesthesia & Analgesia highlights the importance of capnography monitoring via a series of articles under important categories of the Journal. You can consider this edition as ‘Special Capnography Edition.’

Editorial:

Global Capnography to Improve Safety for All Patients: Time for Urgent Action

Ellen P. O’Sullivan, MBBCh, FRCA, FCAI,* Mary T. Nabukenya, MB,† and Mark Newton, MD‡

Key Points:

The importance of universal availability and use of capnography to improve patient safety has followed a slower trajectory.

The success of key global capnography projects in saving lives.

Reviewing the global status of capnography, some pragmatic steps to meet this urgent need must be undertaken.

Anesthesiologists and anesthesia providers worldwide know that capnography saves lives, and therefore, this is the time for urgent action.

The Open Mind:

Getting Capnography to the Front Lines

Robert J. McDougall, MBBS, FANZCA,* Wayne W. Morriss, MBChB, FANZCA,†‡ Priya K. Desai, MPH,§ and Natsagdorj Batgombo, MD‖

The introduction of pulse oximetry and capnography helped revolutionize modern anesthesia in the 1980s.

Pulse oximetry has achieved widespread use because of the simplicity and robustness of the devices. It can be understood by non-medical personnel.  Global Oximetry Projects facilitated pulse oximetry use in many low-resource countries for surgical procedures. Lifebox and Smiletrain projects also helped in the widespread use of pulse oximetry.

On the other hand, capnography has yet to match the widespread use of pulse oximetry.

Low-cost capnography units exist and, therefore, must facilitate more comprehensive use of capnography worldwide.

Efforts such as building a coalition, setting the standards, securing funding, developing training tools, and manufacturing and distributing capnography units must be undertaken to close the Capnography Gap.

Infographics:

Nice illustration of Closing the Capnography Gap: The Capnography Project.

Illustrates the results of Capnography Project: introduction of capnography in Malawi and other African countries.

After introducing capnography, 77% of providers recognized complications, including 44 esophageal intubations.

90% of providers believed that capnography had saved lives.

 

Conclusion: Solving the global capnography gap will improve patient safety worldwide.

 

Narrative Review Article

Capnography—An Essential Monitor, Everywhere: A Narrative Review

Elliot A. Wollner, MBBS, MPH,*† Maziar M. Nourian, MD,‡ Ki K. Bertille, MD,§ Pauline B. Wake, MBBS, DA, MMED,∥ Michael S. Lipnick, MD,¶ and David K. Whitaker, FRCA, FFPMRCA, FFICM, FFARCSI (Hon)#

Abstract:

Capnography is now recognized as an indispensable patient safety monitor. Evidence suggests that its use improves outcomes in operating rooms, intensive care units, and emergency departments, as well as in sedation suites, in postanesthesia recovery units, and on general postsurgical wards. Capnography can accurately and rapidly detect respiratory, circulatory, and metabolic derangements. In addition to being useful for diagnosing and managing esophageal intubation, capnography provides crucial information when used for monitoring airway patency and hypoventilation in patients without instrumented airways. Despite its ubiquitous use in high-income-country operating rooms, deaths from esophageal intubations continue to occur in these contexts due to incorrect use or interpretation of capnography. National and international society guidelines on airway management mandate capnography’s use during intubations across all hospital areas, and recommend it when ventilation may be impaired, such as during procedural sedation. Nevertheless, capnography’s use across high-income-country intensive care units, emergency departments, and postanesthesia recovery units remains inconsistent. While capnography is universally used in high-income-country operating rooms, it remains largely unavailable to anesthesia providers in low- and middle-income countries. This lack of access to capnography likely contributes to more frequent and serious airway events and higher rates of perioperative mortality in low- and middleincome countries. New capnography equipment, which overcomes cost and context barriers, has recently been developed. Increasing access to capnography in low- and middle-income countries must occur to improve patient outcomes and expand universal health care. It is time to extend capnography’s safety benefits to all patients, everywhere. (Anesth Analg 2023;137:934–42).

 

Video:

Capnography: Video in Clinical Anesthesia

Austin Snyder, MD, Dhanesh Binda, BS, Jean-Luc Germany, MD, Victoria Rosales, MD, Faisal Tan, MD, Ala Nozari, MD, PhD, and Rafael Ortega, MD

This article highlights indications, principles of operation, data interpretation, proper use of capnography, common problems and limitations, and trouble shooting.

The information detailed in this article can be found under various sections of capnography.com