Preventing Postoperative Opioid-Induced Respiratory Depression Through Implementation of an Enhanced Monitoring Program

Abstract

Background: Opioid-induced respiratory depression (OIRD) is a serious complication that can lead to negative outcomes. There are known risk factors for OIRD; however, a lack of national guidelines for the prevention and early detection of OIRD exists. Methods: An evidence-based practice study was conducted to create an enhanced monitoring (EM) program. The EM program consisted of risk stratification of surgical spine patients, including the use of STOP-BANG screening for obstructive sleep apnea, capnography monitoring, use of home positive airway pressure therapy, capnography alarm optimization, hospitalist consultation, nursing education, and patient education.Results: Approximately 17% (N 5 937/5,462) of surgical spine patients were enrolled in the EM program. Fifty-six percent of EM patients were monitored with capnography and had out of range end-tidal carbon dioxide levels 17% of the time. The rate of transfers to the intensive care unit (ICU) for OIRD decreased, though not statistically significant (p 5 .151). Conclusions: The EM program with risk stratification was found to reduce transfers to the ICU for OIRD. Although not statistically significant, the decreased number of transfers was clinically significant. Engagement of the interprofessional team and capnography alarm parameter optimization helped to reduce nonactionable alarms.

Nocturnal respiratory abnormalities among ward-level postoperative patients as detected by the Capnostream 20p monitor: A blinded observational study

“…The median ASA score was two (IQR 2-3). The median ARISCAT score was 19 (IQR [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Most patients underwent orthopedic surgery (52.8%) followed by intra-abdominal (28%) and bariatric surgery (19.2%).…”

“…Capnography offers sensitive continuous monitoring of respiratory rate, which is often the first vital sign to become abnormal in an opioid-related respiratory depression event [43]. Implementing continuous capnography has been shown to reduce activation of rapid response teams and to reduce transfers to a higher-level care ward [21,22]. However, whether it improves patient outcomes overall remains to be seen [20].…”

“…Continuous capnography overcomes the existing limitations of intermittent nursing monitoring for surgical patients. Continuous capnography has been used effectively to detect apnea and respiratory depression in many settings [17,[20][21][22]. Most modern capnography monitors are mobile and can be coupled with algorithms that integrate values from other sources, such as continuous oximetry, to provide real-time indices that can act as warning systems to help guide clinical decision-making [17,23].…”

The Effect of Cryo-auriculotherapy on Post-Operative Pain Management following Rotator Cuff Surgery: A Randomized, Placebo-Controlled Study

“…(1) Furthermore, the use of opioids is associated with significant adverse effects in the context of surgery, including postoperative nausea and vomiting, respiratory depression, hypotension, immunosuppression, and constipation. (2)(3)(4)(5) Although interscalene block is the gold standard for postoperative pain management following shoulder surgery, the duration of the block only covers the initial rehabilitation period, and in most cases, patients require the use of opioids. (6) Auriculotherapy is a non-invasive, complementary technique that has been studied in several surgical models, including tooth extraction, (7,8) hip arthroplasty, (9) gynecologic procedures, (10,11) and depression.…”