Respiratory monitoring during pediatric sedation: pulse oximetry and capnography.

A major concern in pediatric dentistry is maximizing risk management through optimal monitoring of respiratory function during sedation techniques. This article examines the problems inherent in respiratory monitoring in sedated pediatric dental patients, the traditional methods of respiratory monitoring, and new technologies which are useful in optimizing respira tory monitoring. The authors discuss transcutaneous oximetry and pulse oximetry as possible monitors of oxygenation, and capnography as a possible monitor for apnea, airway obstruction, and developing hypoventilation. Risk management involves striving for maximum patient safety and should be a primary concern to all dentists and physicians practicing conscious or deep sedation. A major component of risk management for sedation or anesthesia involves physiologic monitoring. Monitoring may be defined as continuous observation of data from specific organ systems to evaluate the status of physiologic function. The purpose of monitoring is to permit prompt recognition of any deviation from normal, so corrective therapy can be instituted before morbidity ensues. Ideal monitors should be continuous or "real time", rapidly responsive, noninvasive, accurate, dependable, convenient, and affordable. The principal systems monitored during pediatric sedation are the central nervous, cardiovascular, and respiratory systems. This discussion reviews monitoring of the respiratory system. There is compelling evidence that this is the most important system to monitor for pediatric patients. Furthermore, major scientific advances are being made in this area which should be understood by all who use sedation and/or anesthesia, especially those who treat pediatric patients.