26 - Respiratory Depression: Incidence, Diagnosis, and Treatment  pp. 416-430

Respiratory Depression: Incidence, Diagnosis, and Treatment

By Dermot R. Fitzgibbon

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The overall effectiveness of any analgesic technique depends on the adequacy of pain relief that can be provided and the incidence of side effects or complications. Opioids represent the major class of analgesics for treating severe and unremitting pain and are widely used in the treatment of pain associated with surgery or chronic conditions. Most modern postoperative analgesic techniques incorporate the administration of neuraxial opioids (with or without local anesthetic) or systemic (usually by patient-controlled analgesia [PCA]) routes. Although opioid administration is generally considered safe on surgical wards, respiratory depression associated with opioids occur and have the potential for major morbidity and even mortality. Serious complications or deaths from opioid-induced respiratory depression are rare, but the risk is not zero, and a death or neurologic injury for a patient with an otherwise treatable illness is tragic. In July 2000, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) developed new standards to create higher expectations for the assessment and management of pain in hospitals and other health care settings in the United States. In response, many institutions implemented treatments guided by patient reports of pain intensity indexed with a numerical scale. Vila et al reported that the incidence of opioid oversedation per 100,000 inpatient hospital days increased from 11.0 pre-numeric pain treatment algorithm (NPTA) to 24.5 post-NPTA (P <.001). Of these patients, 94% had a documented decrease in their level of consciousness preceding the event.