During emergency department procedural sedation, some clinicians (myself included) advocate non-invasive capnography for the early detection of apnoea. Others argue against routine administration of oxygen so that if desaturation occurs it provides an earlier more correctable warning of respiratory depression than if it occurs on supplemental oxygen. A Canadian study using prospective data from research on propofol with either ketamine or fentanyl compared changes in capnography with desaturation in sedated patients breathing only room air. Desaturation detectable by pulse oximeter occurred before overt changes in capnometry were identified.

It’s hard to ascertain the relevance of this finding. The authors wisely state ‘these findings should not be extrapolated to patients administered supplemental oxygen where it is possible capnometry may be helpful’. Since I use capnography in the hope that it will assist in the earlier detection of ketamine-associated laryngospasm in children, I’m not going to discard it in favour of waiting for the saturation to fall. Perhaps we just need to be clear that capnography may be more useful at detecting apnoea than hypoventilation.
A comparative evaluation of capnometry versus pulse oximetry during procedural sedation and analgesia on room air
CJEM. 2010 Sep;12(5):397-404