Due to the potential that respiratory function may become impaired as a result of sedation-induced depression of the central nervous system, frequent monitoring is recommended. However, PSA is still associated with at the least the same or potentially even greater risk of serious sedation-related adverse events, such as death or permanent neurological disability, compared with general anaesthesia. Loss of consciousness is not an intended outcome, and cardiac and respiratory function may not be impaired with the doses and types of sedative and analgesic medications used. PSA is generally considered to include the stages of moderate and deep sedation of the continuum of anaesthesia. Procedural sedation and analgesia (PSA) is used to control pain and distress during diagnostic and interventional medical procedures. Meta-analyses will be performed if suitable. The Cochrane risk of bias tool will be used to assign a judgment about the degree of risk. Screening, study selection and data extraction will be performed by two reviewers. Studies that included patients who received general or regional anaesthesia will be excluded from the review. Electronic databases will be searched for parallel, crossover and cluster randomised controlled trials comparing the use of capnography with standard monitoring alone during PSA that is administered in the hospital setting.
The potential adverse effect of capnography monitoring that will be examined in this review is the rate of inadequate sedation. A secondary objective of this review is to determine whether changes in the clinical management of sedated patients are the mediating factor for any observed impact of capnography monitoring on the rate of hypoxaemia. The primary objective of this review is to determine whether using capnography during PSA in the hospital setting improves patient safety by reducing the risk of hypoxaemia (defined as an arterial partial pressure of oxygen below 60 mmHg or percentage of haemoglobin that is saturated with oxygen less than 90 %).
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