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"ANESTHESIA MONITORING - applicable to all anesthesia...Ventilation as noted by:....Monitoring of end tidal expired CO₂ including volume, Capnography/Capnometry or mass spectroscopy"

AAP 1992

American Academy of Pediatrics Standards

Deep sedation and general anesthesia are virtually inseparable for purposes of monitoring. (See ASA 99 and JCAHO 99)

AARC 2003

American Association for Respiratory Care

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Capnography ....... may be indicated for: Evaluation of the exhaled [CO₂], especially end-tidal CO₂; Monitoring severity of pulmonary disease and evaluating response to therapy; as an adjunct to determine that tracheal rather than esophageal intubation has taken place; continued monitoring of the integrity of the ventilatory circuit; evaluation of the efficiency of mechanical ventilatory support; monitoring adequacy of pulmonary, systemic, and coronary blood flow; monitoring inspired CO₂ when CO₂ is being therapeutically administered; graphic evaluation of the ventilatory-patient interface; measurement of the volume of CO₂ elimination to assess metabolic rate and/or alveolar ventilation.

ACEP 2002

American College of Emergency Physicians Standards

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"End-tidal CO₂ detection, either qualitative, quantitative or continuous, is the most accurate and easily available method to monitor correct endotracheal tube position in patients who have adequate tissue perfusion."

AHA 2000

American Heart Association

Emergency responders must confirm tracheal tube position by using nonphysical examination techniques. These include esophageal detector devices, quantative end-tidal C02 indicators, and capnographic and capnometric devices, this includes capnography.

Anesthesia Patient Safety Foundation

?Thus, immediately, we urge health care professionals to consider the potential safety value of continuous monitoring of oxygenation (pulse oximetry) and ventilation in patients receiving PCA or neuraxial opioids in the postoperative period. Although pulse oximetry will monitor oxygenation during PCA, it may have reduced sensitivity, as a monitor of hypoventilation, when supplemental oxygen is administered.When supplemental oxygen is indicated, monitoring of ventilation may warrant the use of technology designed to assess breathing or estimate arterial carbon dioxide concentrations.Continuous monitoring is most important for the highest risk patients, but depending on clinical judgment, should be applied to other patients?.Thus, available monitoring resources will need to be directed to those patients at greatest risk of opioid-induced respiratory depression. In particular, continuous monitoring should be strongly considered in any patient with significant OSA receiving PCA or neuraxial opioids. ASA 2002

American Society of Anesthesiologists

?Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists ?In circumstances where patients are physically separated from the care giver, the Task Force believes that automated apnea monitoring (by detection of exhaled CO₂ or other means) may decrease risks during both moderate and deep sedation?? ?Monitoring of exhaled CO₂ should be considered for all patients receiving deep sedation and for patients whose ventilation cannot be directly observed during moderate sedation.?

Summary of ASA Practice Guidelines for the Perioperative management of patients with Obstructive Sleep Apnea - October 25, 2005

Postoperative Management OSA patients should be monitored for a median of 3 hours longer than the non-OSA counterparts before discharge. Monitoring of OSA patients should continue for a median of 7 hours after the last episode of airway obstruction of hypoxemia. Post-operative concerns include the exacerbation of respiratory depression on the third or fourth postoperative day as sleep patterns are re-established and "REM rebound" occurs.

ASA 1999

?Every patient receiving general anesthesia shall have the adequacy of ventilation continually evaluated. Qualitative clinical signs such as chest excursion, observation of the reservoir breathing bag and auscultation of breath sounds are useful. Continual monitoring for the presence of expired carbon dioxide shall be performed unless invalidated by the nature of the patient, procedure or equipment. Quantitative monitoring of the volume of expired gas is strongly encouraged.? (The mandatory use of CO₂ monitoring will apply to wherever drugs that are capable of interfering with airway protective reflexes are given. ) (General anesthesia, Procedural Sedation, Analgesia) (Intubated, non- intubated, in and out of the OR)

ASA Standards for Basic Anesthetic Monitoring

Approved by House of Delegates on October 21, 1986 and last amended on October 21, 1998 - implementation July 1, 1999.

When an endotracheal tube or laryngeal mask is inserted, its correct positioning must be verified by clinical assessment and by identification of carbon dioxide in the expired gas. Continual end-tidal carbon dioxide analysis, in use from the time of endotracheal tube/laryngeal mask placement, until extubation/removal or initiating transfer to a postoperative care location, shall be performed using a quantitative method such as capnography, capnometry or mass spectroscopy.

SCCM 1999

Society of Critical Care Medicine

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The Society of Critical Care Medicine recommends that all ICUs be capable of providing capnographic monitoring.

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