The use of pulse oximetry during CS is important. By 1990, more than 80 deaths had been reported following the use of midazolam, commonly in conjunction with an opioid, for sedation.11 Coadministration of midazolam (0.05 mg/kg) and fentanyl (2.0 pg/kg) to 12 healthy volunteers produced hypoxemia (Sa o2 <90 percent for longer than 10 s) in 11 and apnea in 6.11 A study of pulse oximetry and nasal end-tidal CO2 values in 27 ED patients who were sedated with benzodiazepines and/or opiates for a painful procedure noted that one patient developed clinically significant apnea and eight developed clinically silent hypoxemia. 12 The American Medical Association's (AMA) Council on Scientific Affairs subsequently called for the development of standards by specialty societies for the use of pulse oximetry during conscious sedation.13 Several authors have noted that when oxygen supplementation is given, extreme ventilatory insufficiency may develop in the absence of hypoxemia. The clinical significance of hypoxemia during sedation is still uncertain, but abnormal pulse oximetry certainly counsels providers to evaluate the patient carefully.
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