Extended monitoring in gastroenterology: capnography, monitoring depth of sedation, and computer-assisted propofol sedation

This chapter is concerned with “extended monitoring” and “advanced sedation” in gastroenterology. Topics discussed include capnography, monitoring depth of sedation, and computer-assisted propofol sedation. Although classical “hands-on” and “eyes-on” monitoring methods remain indispensable in monitoring patients undergoing gastrointestinal (GI) endoscopic procedures, some newer monitoring technologies are proving to be useful as well and are discussed. The chapter begins by examining the role that capnography plays in the respiratory monitoring of unintubated patients receiving sedation. Sample capnographic waveforms are provided and the results of recent GI capnographic studies are summarized. The discussion then switches to electronic processing of the electroencephalogram (EEG) as a means to estimate depth of sedation. Studies of processed EEG in the setting of GI endoscopy are also discussed. Finally, we discuss the use of computers to automate drug delivery for the purpose of providing sedation for GI endoscopic procedures.