SAAD Digest 

March 2026
Volume: 42
Issue: 1
DOI: 10.63507/XHSW507

Title: Should capnography be compulsory for dental sedation in medically complex patients (ASA III/IV)?

Author(s): C E Y. Draper

Abstract:
Conscious sedation is a useful tool for treating dental phobic and medically complex patients, but side effects include hypoxaemia and hypoxia. Conscious sedation is usually monitored via clinical monitoring and the use of pulse oximetry, which measures oxygen saturation levels and signals when rescue measures may be required. Capnography monitoring is suggested to be an earlier indicator of adverse events, which measures the concentration of carbon dioxide in the patient’s expired air sample.

American Society of Anaesthesiologist (ASA) class III and IV or ‘medically complex’ patients are at a higher risk of adverse events during sedation. Current UK guidelines state that capnography is not compulsory during procedural sedation for dental procedures but could be suitable for certain high-risk ASA grade III/IV dental patients, especially those receiving supplemental oxygen.

This review will explore the literature investigating the benefit of capnography monitoring for medically complex patients undergoing dental sedation. Studies suggest that capnography is superior to pulse oximetry in preventing and detecting hypoxaemia alongside other adverse events, but more specifically when supplemental oxygen is required. ASA III/IV patients may therefore benefit from capnography being used as a standard monitoring technique.

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Articles from Digest 42(I)