Multilayer intraoperative monitoring: clinical use of capnography during neuraxial block in Port Harcourt, Nigeria
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Abstract
Background: The concept of multilayer defence, often applied in advanced air defence systems, is also relevant in perioperative patient safety through the use of multiple, complementary monitoring modalities. Capnography, which provides continuous real-time assessment of end-tidal carbon dioxide (EtCO₂), is traditionally employed during general anaesthesia but has emerging value as an additional layer of intraoperative monitoring during neuraxial anaesthesia.
Aim: To evaluate the impact of incorporating capnography as an adjunct to standard monitoring on respiratory event detection and patient satisfaction during neuraxial anaesthesia.
Methods: A randomised controlled trial was conducted across five hospitals in Port Harcourt, Nigeria, all equipped with capnography facilities. A total of 250 adult patients undergoing elective surgery under neuraxial anaesthesia were randomly allocated to two groups: Group A (standard monitoring) and Group B (standard monitoring plus capnography). Primary outcomes included the ability to detect apnoea, sedation-related respiratory changes, and sudden desaturation. Secondary outcomes were operative duration and patient satisfaction. Data were analysed using IBM SPSS version 26.
Results: Capnography enabled earlier detection of desaturation events—within 20 seconds—compared to pulse oximetry, and identified apnoea and sedation-related respiratory pattern changes in 98% of cases. No significant difference in operative duration was observed between the two groups. Patient satisfaction was significantly higher in the capnography group (mean score: 4.5 ± 0.4) compared to the standard monitoring group (3.9 ± 0.5; p < 0.001).
Conclusion: The addition of capnography to standard monitoring during neuraxial anaesthesia significantly enhances perioperative safety through earlier recognition of respiratory compromise and improved patient satisfaction.
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References
Saunders R, Struys MMRF, Pollock RF, Mestek M, Lightdale JR. Patient safety during procedural sedation using capnography monitoring: a systematic review and meta-analysis. BMJ Open 2017;7(6):e013402.
Kodali BS. Capnography outside the operating rooms. Anesthesiology 2013;118(1):192-201.
Hutton M, Brull R, Macfarlane AJR. Regional anaesthesia and outcomes. BJA Educ 2018;18(2):52-56.
Somboonviboon W, Kyokong O, Charuluxananan S, Narasethakamol A. Incidence and risk factors of hypotension and bradycardia after spinal anaesthesia for cesarean section. J Med Assoc Thai 2008;91(2):181-187.
Jabre P, Jacob L, Auger H, Jaulin C, Monribot M, Aurore A, et al. Capnography monitoring in nonintubated patients with respiratory distress. Am J Emerg Med 2009;27(9):1056-1059.
Manifold CA, Davids N, Villers LC, Wampler DA. Capnography for the nonintubated patient in the emergency setting. J Emerg Med 2013;45(4):626–632.
Conway A, Douglas C, Sutherland J. Capnography monitoring during procedural sedation and analgesia: a systematic review protocol. Syst Rev 2015;4:92.
American Society of Anesthesiologists. Standards for basic anaesthetic monitoring. ASA, 2020. Available from: https://www.asahq.org/standards-and-guidelines. Accessed 5th July 2025.
World Health Organisation. Global patient safety action plan 2021–2030: towards eliminating avoidable harm in health care. Geneva: WHO, 2021.
Krauss B, Hess DR. Capnography for procedural sedation and analgesia in the emergency department. Ann Emerg Med 2007;50(2):172–181.
Weiniger CF, Akdagli S, Turvall E, Deutsch L, Carvalho B. Prospective observational investigation of capnography and pulse oximetry monitoring after cesarean delivery with intrathecal morphine. Anesth Analg 2019;128(3):513-522.
Langhan ML, Chen L, Marshall C, Santucci KA. Detection of hypoventilation by capnography and its association with hypoxia in children undergoing sedation with ketamine. Pediatr Emerg Care 2011;27(5):394-397.
Uppal V, Sondekoppam RV, Landau R, El-Boghdadly K, Narouze S, Kalagara HKP. Neuraxial anaesthesia and peripheral nerve blocks during the COVID-19 pandemic: a literature review and practice recommendations. Anaesthesia 2020;75(10):1350-1363.
Waugh JB, Epps CA, Khodneva YA. Capnography enhances surveillance of respiratory events during procedural sedation: a meta-analysis. J Clin Anesth 2011;23(3):189-196.