Capnometry and anaesthesia

In the last decade, capnography has developed from a research instrument into a monitoring device considered to be essential during anaesthesia to ensure patient safety. Hence, a comprehensive understanding of capnography has become mandatory for the anaesthetist in charge of patients in the operating room and in the intensive care unit. This review of capnography includes the methods available to determine carbon dioxide in expired air, and an analysis of the physiology of capnograms, which are followed by a description of the applications of capnography in clinical practice. The theoretical backgrounds of the effect of barometric pressure, water vapour, nitrous oxide and other factors introducing errors in the accuracy of CO2 determination by the infra-red technique, currently the most popular method in use, are detailed. Physiological factors leading to changes in end-tidal carbon dioxide are discussed together with the clinical uses of this measurement to assess pulmonary blood flow indirectly, carbon dioxide production and adequacy of alveolar ventilation. The importance of understanding the shape of the capnogram as well as end-tidal carbon dioxide measurements is emphasized and its use in the early diagnosis of adverse events such as circuit disconnections, oesophageal intubation, defective breathing systems and hypoventilation is highlighted. Finally, the precautions required in the use and interpretation of capnography are presented with the caveat that although no instrument will replace the continuous presence of the attentive physician, end-tidal carbon dioxide monitoring can be effective in the early detection of anaesthesia-related intraoperative accidents.