Capnograph Guided Ventilation During Cleft Lip Repair Surgery
Ama Taplah, BSN, MPH, RNA, Diana Park, MSN, CRNA, Patricia O’Connor, Huma Hussain, MD, Edward Clune, MD, Robina Matyal, MD
Published December 2, 2024 | Clinics in Medical Education
Issue 4 | Volume 1 | November 2024
Every month, the Boston Africa Anesthesia Collaborative (BAAC) hosts grand rounds, providing a platform for healthcare professionals to share cases and insights in anesthesia practice across resource-limited settings in Liberia. The October grand rounds session showcased a case, where local nurse anesthetists, supported by BAAC, are advancing anesthesia safety through improved access to capnography monitoring.
Ama Taplah, a nurse anesthetist, presented a case on capnography-guided ventilation during cleft lip repair surgery, highlighting the clinical impact of capnography on surgical outcomes. A three-month-old infant with right unilateral cleft lip underwent surgical repair at JFK Medical Center in Monrovia,
Liberia. Throughout the procedure, capnography provided continuous monitoring of end-tidal CO2 (ETCO2), offering real-time feedback on the ventilation status and alerting the team to hypercapnia early on. These ventilatory modifications resulted in the gradual normalization of CO2 levels, with stable postoperative respiratory and hemodynamic status observed during recovery. This case highlights the value of capnography as a tool for managing anesthesia, especially in preventing complications arising from ventilation-perfusion mismatches.
Diana Park, CRNA, at Beth Israel Deaconess Medical Center in Boston, shared how BAAC and Liberian nurse anesthetists are closing critical gaps in anesthesia through a collaborative initiative that improves access to capnography monitoring. Capnography remains unavailable in many low-resource
settings, compromising patient outcomes. Recognizing this, Liberian nurse anesthetists undertook a national assessment to document the scarcity of capnography, revealing disparities in access. Of the few available units, distribution and routine use were inconsistent across health facilities.
Supported by the Boston Africa Anesthesia Collaborative (BAAC), six capnographs were provided to priority hospitals, each accompanied by hands-on training for local nurse anesthetists. Within weeks, these monitors were integrated into daily patient care, enabling safer anesthesia management and timely
interventions. A follow-up assessment conducted five months post-deployment confirmed sustained use.
The impact of this initiative resonates through testimonials from Liberian nurse anesthetists who now use capnography. “With the capnograph machine, our intubations have improved, and tubes are secure, as the CO2 reading gives us confidence.” Such feedback highlights not only the clinical benefits of capnography but also its role in building confidence and skills among local practitioners, contributing to safer anesthesia practices across Liberia.