The role of capnography in improving respiratory safety during pediatric endoscopic procedures: An observational study

Endoscopic procedures in pediatric patients are increasingly performed under sedation in non-operating room anesthesia settings, where early detection of respiratory compromise is essential. While capnography is recommended for identifying hypoventilation, its clinical impact remains debated. This study aimed to evaluate whether end-tidal carbon dioxide (ETCO 2 ) monitoring reduces the incidence of hypoxia during sedated pediatric endoscopic procedures. This observational study included 135 children aged 1 to 17 years undergoing elective upper gastrointestinal endoscopy or combined endoscopy and colonoscopy under intravenous propofol sedation. Patients were allocated into 2 groups based on the monitoring strategy applied in routine practice: standard monitoring alone or standard monitoring with ETCO 2 . Hypoxia was defined as oxygen saturation < 90% for ≥10 seconds, and hypoventilation as abnormal ETCO 2 patterns. Baseline characteristics, procedural variables, and sedation data were recorded. The primary outcome was the incidence of hypoxia; secondary outcomes included associations between hypoxia and demographic or procedural variables. Hypoxia occurred in 44 (32.6%) of the 135 patients, with a significantly lower incidence in the ETCO 2 group compared with the non-ETCO 2 group (25.0% vs 40.3%, P = .041). Younger age correlated with an increased risk of hypoxia ( r = –0.192, P = .025). No significant differences were found regarding procedure duration, procedure type, or adjunct anesthetic use. All procedures were completed successfully, and no major adverse events occurred. ETCO 2 monitoring significantly reduced the incidence of hypoxia in pediatric patients undergoing endoscopic procedures under sedation. Given the physiological vulnerability of children and the limitations of pulse oximetry alone, ETCO 2 should be considered an essential component of routine monitoring in pediatric non-operating room anesthesia settings.