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Ann Emerg Med. 2007 Jan;49(1):1-8. Epub 2006 Sep 15.

The utility of supplemental oxygen during emergency department procedural sedation and analgesia with midazolam and fentanyl: a randomized, controlled trial.

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1
Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA. deitchk@einstein.edu

Abstract

STUDY OBJECTIVE:

To determine whether supplemental oxygen reduces the incidence of hypoxia by 20% in study patients receiving midazolam and fentanyl for emergency department procedural sedation and analgesia.

METHODS:

Patients were randomized to receive either supplemental oxygen or compressed air by nasal cannula at 2 L per minute. Physicians were blinded to the gas used and end-tidal carbon dioxide (ETCO2) data. Respiratory depression was defined a priori as oxygen saturation less than 90%, ETCO2 level greater than 50 mm Hg, an absolute change from baseline of 10 mm Hg, or loss of the ETCO2 waveform.

RESULTS:

Of the 80 patients analyzed, 44 received supplemental oxygen and 36 received compressed air. Twenty supplemental oxygen patients and 19 compressed air patients met at least 1 criterion for respiratory depression. Six supplemental oxygen patients and 5 compressed air patients experienced hypoxia (P=.97; effect size 0%; 95% confidence interval -15% to +15%). Fourteen patients in each group met ETCO2 criteria for respiratory depression but were not hypoxic. Physicians identified respiratory depression in 8 of 11 patients who became hypoxic and 0 of 28 patients who met ETCO2 criteria for respiratory depression but who did not become hypoxic. There were no adverse events.

CONCLUSION:

Supplemental oxygen did not reduce (or trend toward reducing) the incidence of hypoxia in patients moderately sedated with midazolam and fentanyl. However, our lower-than-expected rate of hypoxia limits the power of this comparison. Blinded capnography frequently identified respiratory depression undetected by the treating physicians.

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