Ventilation—Observation, Capnography, and Precordial Stethoscope

A variety of monitoring techniques can be used to ensure adequate ventilation during sedation. Three of the methods are direct observation, precordial/pretracheal stethoscope, and end-tidal CO2 monitoring. Direct observation is simple and effective but may miss subtle changes and is difficult when the room is darkened or the patient is covered. Precordial stethoscopes are frequently utilized during dental procedures and can help detect changes in respiration or the need for suctioning. MRI-compatible versions are available, but the practitioner needs to be within 4 feet of the patient. End-tidal CO2 monitoring gives the most information about the adequacy of ventilation but requires costly equipment and placement of a specialized nasal cannula or mask on the child’s face. The benefit of utilizing any of these modalities is that changes in ventilation will precede changes in oxygenation. Hence, early recognition of change can help prevent respiratory compromise.