Life-threatening critical respiratory events: a retrospective study of postoperative patients found unresponsive during analgesic therapy

Predictors of Delayed Postoperative Respiratory Depression Assessed From Naloxone Administration

“…Others have also found that naloxone is typically administered in the earlier postoperative period. [9][10][11] It is not surprising that our patients with preoperative diagnosis of OSA had higher risk for developing postoperative respiratory depression requiring naloxone. Similarly, patients who had respiratory specific events in recovery room were also at increased risk.…”

“…9 Several studies have examined preoperative risk factors and the administration of naloxone in the postoperative period since the publication of Joint Commission standards. [9][10][11] These have found that older age, presence of comorbidities such as obstructive sleep apnea (OSA), and use of medications such as benzodiazepines were all associated with increased risk for postoperative naloxone administration.…”

Perioperative Complications in Obstructive Sleep Apnea Patients

“…Populations considered to be at higher risk for OIVI include the morbidly obese and those with OSA [56••]. Two recent studies highlight the association between OIVI and OSA, finding in a database analysis that 30 % of patients with postoperative opioid-related life-threatening respiratory events had OSA [57] and that 40 % of postoperative opioid-related deaths in an ASA closed claims registry analysis had known or suspected OSA [58]. Opioids also decrease genioglossus muscle activity and suppress the arousal response to apneas and hypopneas [59], resulting in more frequent and prolonged obstructive events during sleep.…”

Perioperative Management of Obstructive Sleep Apnea

“…Multiple studies have demonstrated the respiratory effects of various postoperative analgesic regimens on ventilatory Principles of management Premedication Avoid sedating premedication [56] Consider Alpha-2 adrenergic agonists (clonidine, dexmedetomidine) [57] Potential difficult airway (difficult mask ventilation and tracheal intubation) [58,59] Optimal positioning (Head Elevated Laryngoscopy Position) if patient obese…”

“…[45, function and apnea episodes. Ramachandran et al [59] concluded that the first 24 h after commencing opioidbased analgesic therapy for acute pain represents a highrisk period for an OSA patient. Blake et al [60] noted in their study on postoperative patient-controlled analgesia that the frequency of central apneas and the rate of respiratory events [15/h were related to the postoperative morphine dose, reinforcing the recommendation that a multimodal approach to analgesia should be used to minimize the use of opioids postoperatively.…”