To Whom It May Concern:

I would like to make a resounding endorsement of the use of End Tidal CO2 monitoring or capnography in sedation and anesthesia.  The gold standard in monitoring for any sort of anesthesia or sedation procedure has always been the American Society of Anesthesiologists Guidelines to Monitoring.  They have routinely recommended the monitoring of ventilation via multiple clinical methods since the guidelines were published.  In 2010, they officially standardized the use of capnography for sedation.  Here is the wording that has been used since 2011:

"“During regional anesthesia (with no sedation) or local anesthesia (with no sedation), the adequacy of ventilation shall be evaluated by continual observation of qualitative clinical signs. During moderate or deep sedation, the adequacy of ventilation shall be evaluated by continual observation of qualitative clinical signs and monitoring for the presence of exhaled carbon dioxide unless precluded or invalidated by the nature of the patient, procedure, or equipment.”"

Dentistry has been hesitant to adopt such standards until recently.  Whether such a decision was driven by antiquated standards, economic concerns, or because practitioners truly felt that dentistry precluded the use of CO2 monitoring,  in 2016 this rational cannot persist.  Patient safety must always be the number one goal in anesthesia, an anesthesiologists motto is "Vigalence." It has never been more important that dentistry stress the importance of this in anesthesia than now, as dentistry's track record of safe anesthesia delivery is being rightfully questioned by the public. 

In addition, medicine is increasingly limiting the practice of operator anesthetists, a model that dentistry still touts as a safe standard of care.  When an anesthetists is both in charge of monitoring a patient and completing a procedure, one has two, and sometimes conflicting, goals.  In reality, many may in fact delegate monitoring to their dental assistants, whom may or may not be adequately trained to monitor adequate respiration before a problem emerges.  Having the additional monitoring of capnography places another line of defense against potentially lethal and tragic complications of anesthesia. 

In addition I believe it should also be considered that the use of End Tidal CO2 monitoring or Capnography should be required for monitoring patients, and not just required as equipment that must be present.  In the anesthesia record, I would recommend that the qualitative presence of CO2 on exhalation should be required ( a quantitative number is often inaccurate unless the patient is intubated because of fresh gas flow to the patient.)

I believe the use of capnography updates the standard of care in dentistry to be more consistent with the medical standard of care.  Therefore, I endorse the use of Capnography or End Tidal CO2 monitoring.

Thank you.