However, in many institutions, capnography is not used to monitor ventilation during sedation for procedures performed particularly by nonanesthesiologists outside of the operating rooms. As anesthesiologists, we use capnography to monitor sedation in the operating room because we appreciate that the line between consciousness and unconsciousness is very thin, and the patient can drift from one state to another. It is even more surprising that many ICUs do not have capnography either to confirm endotracheal intubation or to continually monitor ventilation. It is not uncommon in our practice to observe an intubated and ventilated patient, originally monitored with capnography in the operating room, but then transported to the intensive care unit (ICU) without capnography. Although capnography has become an integral part of anesthesia care in operating rooms for more than 25 yr, its value has been limited to these situations and is not well appreciated beyond these confinements.
Capnography is mandatory for laparoscopic surgeries for reimbursement). Currently, anesthesiologists in many developing countries follow these recommendations (India, Government of Andhra Pradesh Order, AST/775/F25/dated September 2011. Thanks to the foresight of the American Society of Anesthesiologists (ASA), Anesthesia Patient Safety Foundation (APSF), Association of Anaesthetists of Great Britain and Ireland (AAGBI), and the Association of Anesthesiologists in Holland, capnography was embraced and incorporated into the standards of monitoring during anesthesia to enhance patient safety. Such a decrease has not been seen in other medical or surgical specialties over this time frame. In the United States, since 1985, there has been a dramatic decrease in the malpractice insurance premiums of anesthesiologists. HISTORICALLY, anesthesiologists seem to be the forerunners in implementing tools and standards for safety in the medical fraternity.
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