URL: , Institution:  Harvard Medical School, Brigham and Women’s Hospital, Department of Anesthesia, Boston, Massachusetts , Author/Webmaster:  Bhavani-Shankar Kodali, M.D. , Jeffrey M. Cusick, M.D. , Director of Anesthesiology , 56th Medical Group , Luke Air Force Base, Arizona , Preceptor of Anesthesiology , Midwestern University , Arizona College of Osteopathic Medicine, Glendale, Arizona ,

Dr. Bhavani-Shankar Kodali, a well-published expert on the subject of capnography, has created the Capnography Web site without sponsorship from any equipment or pharmaceutical company. His purpose is to fulfill his “long-standing goal of developing an easily accessible educational and interactive site on capnography, that cannot only address the basic principles but also be a forum for active discussion and learning on issues related to capnography in all medical fields.”

Animated Graphics

Unlike a textbook, a Web site can contain interactive media to assist in the understanding of concepts. The Capnography Web site makes use of animated graphics known as animated .gif files. They provide a dynamic visual presentation, which facilitates easy learning. Capnographic tracings move across the screen as they do in a real capnograph. In addition, areas of interest are sometimes highlighted and labeled over time. The process then loops back to the beginning to be repeated.

Organization of the Site

The Web site is well-organized and easy to use. It presents a scrolling frame on the left with labeled buttons to access the various areas of interest. The section entitled ASA Guidelines discusses the changes in standards pertaining to expired carbon dioxide monitoring. 1The basic knowledge area, called Why Capnography?, includes sections about physics, physiology, terminology, definitions, and clinical uses. The Capno-Encyclopedia contains an atlas of capnograms. Capno-Tips contains pointers for making the best use of capnography. The Capno-Quiz section can test your knowledge about capnography. The Capno-Magic Screen section pops up as a separate window and shows capnography tracings for more than 30 different clinical situations when the cursor is placed over the text of a subject. The Capno-Pitfalls section outlines major limitations of time capnography. The following separate sections are also included: Capnography in Pediatrics, Laparoscopy, Thoracic Surgery, and Intensive Care. A list of frequently asked questions is included, and the site has a guest book to leave comments.

Quality of Material

The Web site was written by the author with assistance from two contributors for technical consultation and creation of animations. The author has considerable experience related to capnography at a major academic center and has published many articles in established journals. There is some overlap and repetition of information throughout the various sections, which could benefit from minor reorganization. The sections are well-referenced, with many cited articles written by the author himself. The site offers excellent educational material, including a quiz area to test knowledge.

Site Incompatibilities

The layout, formatting, and compatibility of the site could be improved. Odd highlighting of text with overuse of many different background colors detracts from the site’s readability. The Web site requires Internet Explorer Web browser (Microsoft, Redmond, WA) with a Microsoft Windows operating system to function properly. Unfortunately, the home page is a blank white screen when viewed with the latest Internet Explorer 5 with Macintosh operating systems 9.1 and X (Apple, Cupertino, CA). In Netscape Navigator 4.7 (Netscape Communications, Mountain View, CA), the Capno-Magic Screen is inoperable because of JAVA incompatibilities. In other browsers where JAVA is functional, highlighted text is invisible. Fortunately, the animated graphics are compatible with most Web browsers.


Dr. Kodali has put forth great effort to produce the equivalent of a capnography textbook and made it freely available on the Internet. The site provides a complete review of end-tidal carbon dioxide monitoring during anesthesia and intensive care. In addition, his Web site provides animated graphics that are not possible to produce in a textbook and can greatly facilitate learning. The site could benefit from decreased use of distracting colors and improved compatibility, but these deficiencies can easily be overcome. is truly an “all-in-one” for the subject of capnography and a great teaching contribution.

Standards for Basic Anesthetic Monitoring, Policy Statement on Practice Parameters, Standards of the American Society of Anesthesiologists. Park Ridge, American Society of Anesthesiologists, October 21, 1998