Endtidalcarbondioxide Monitoring
Condition: Gastrointestinal Dysfunction
Study type: Interventional

Summary: 
      Does Endtidalcarbondioxide Monitoring in Gastrointestinal Endoscopy Have a Clinical
      Advantage?
    

Detailed description: 
      This study will be randomized prospectively and conducted in Sancaktepe Prof.Dr. Dr. İlhan
      Varank Training and Research Hospital Endoscopy Unit. After the approval from institute
      ethics committee, and obtaining written informed consent, sixty patients with ASA I-II who
      underwent lumbar spinal surgery between 18 and 65 years of age were included in the study.
      Patients with existing heart and lung disease, liver and kidney failure, morbidly obese,
      using psychiatric drugs, having malignancy, pregnant and lactating patients will not be
      included in the study. All patients admitted to the endoscopy unit will be monitorized for
      noninvasive arterial blood and BiS (Bispectral Index) monitorization. Some of the patients
      will undergo standard monitoring HR (heart rate) and SpO2 (peripheral oxygen saturation).
      Other patients will be placed in appropriate nasal cannula Capnostream 20p / Coviden for
      etCO2 (End tidal CO2), RR (Respitarory rate), SpO2 and PR (heart rate) monitorization. Prior
      to endoscopic intervention, fentanyl 1mcgr/kg iv and propofol 1mg/kg iv will be administered
      to patients for sedation. During the procedure, the BiS value will be arranged 60-85 and
      propofol 10-30 mg will be administered intravenously if necessary. If sedation is
      insufficient, fentanyl 25 mcg iv will be added. After baseline values are recorded mean
      arterial pressure, BiS values, etCO2, RR, SpO2, PR, iPi (Integrated Pulmonary Index) score
      values will be recorded at 5 minute intervals after the procedure has started. At the end of
      the procedure, ODI (Oxygenesaturation Index), A/Hr (hourly apnea) values will be recorded.

      Undesirable events like apnea, desaturation will be intervened and duration of it will be
      recorded. Apnea is described as the breathing stops (ETCO2 = 0mmHg, RR = 0 ) for more than 30
      seconds and desaturation is described the fall in SpO2 value below 4% of initial value
      lasting for at least 4 minutes. When apnea and desaturation are seen, verbal stimulation, jaw
      lifting maneuver and oxygen flow will be increased. If the apnea and desaturation periods of
      the patients are prolonged or the SpO2 value falls below 10% of the initial value despite the
      interventions, the procedure will be terminated and necessary procedures will be performed to
      ensure airway safety and the study will be terminated.

      Patients who have completed the endoscopic intervention will be taken to the recovery unit
      and the Fast-tracking recovery score will be calculated at 10 minute intervals in the first
      hour. The time that the fast-tracking score is 14 will be recorded. Patients with two
      consecutive Fast-tracking recovery score values 14 will be discharged. Patients will be
      called after 24-48 hours and questioned if they have symptoms such as abdominal distension,
      fever, nausea and vomiting, dizziness and weakness. The satisfaction score to the patient
      will be questioned; 1:not satisfied at all, 2: not satisfied, 3: neutral, 4:satisfied, 5:
      very satisfied.
    

Intervention name(s): Capnostream 20p / Coviden; Rutine monitoring
Intervention type(s): Device; Device
Intervention description(s): The special nasal canule is used for detection carbondioxide from breathe of patients; peripheric Oxygen saturation is monitored.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Screening