The effect of dental scaling noise during intravenous sedation on acoustic respiration rate (RRa™)

Abstract

Background: Respiration monitoring is necessary during sedation for dental treatment. Recently, acoustic respiration rate (RRa™), an acoustics-based respiration monitoring method, has been used in addition to auscultation or capnography. The accuracy of this method may be compromised in an environment with excessive noise. This study evaluated whether noise from the ultrasonic scaler affects the performance of RRa in respiratory rate measurement.

Methods: We analyzed data from 49 volunteers who underwent scaling under intravenous sedation. Clinical tests were divided into preparation, sedation, and scaling periods; respiratory rate was measured at 2-s intervals for 3 min in each period. Missing values ratios of the RRa during each period were measuerd; correlation analysis and Bland-Altman analysis were performed on respiratory rates measured by RRa and capnogram.

Results: Respective missing values ratio from RRa were 5.62%, 8.03%, and 23.95% in the preparation, sedation, and scaling periods, indicating an increased missing values ratio in the scaling period (P < 0.001). Correlation coefficients of the respiratory rate, measured with two different methods, were 0.692, 0.677, and 0.562 in each respective period. Mean capnography-RRa biases in Bland-Altman analyses were -0.03, -0.27, and -0.61 in each respective period (P < 0.001); limits of agreement were -4.84-4.45, -4.89-4.15, and -6.18-4.95 (P < 0.001).

Conclusions: The probability of missing respiratory rate values was higher during scaling when RRa was used for measurement. Therefore, the use of RRa alone for respiration monitoring during ultrasonic scaling may not be safe.

Keywords: Acoustic Respiration Rate (RRa™); Respiratory Rate; Scaler; Sedation.

Fig. 1. A, Sedation is performed using a nasal cannula and acoustic respiration rate (RRa) sensor. B, Respiratory rate of 14 is observed on RRa monitor. C, Respiratory rate on capnography is monitored using a BM7 monitor. D, Scaling under sedation is performed.

Fig. 2. Stored capnogram wave was confirmed, and the numbers of respiratory rates with capnogram and acoustic respiration rate (RRa) were extracted at 2-s intervals. Values not recorded on RRa were defined as missing values.

Fig. 3. Correlation coefficient and distribution of respiratory rates measured by capnogram and acoustic respiration rate (RRa). RRcapn: Respiratory rate measured by capnography, bpm :breath per minute.

Fig. 4. Bland-Altman plot with bias and limits of agreement for respiration rate, measured by capnography versus noninvasive acoustic respiration rate (RRa). RRcapn: Respiratory rate measured by capnography, bpm: breath per minute.