title: Predictors of Delayed Postoperative Respiratory Depression Assessed from Naloxone Administration.
abstract: BACKGROUND
  The aim of this study was to identify patient and procedural characteristics associated with postoperative respiratory depression or sedation requiring naloxone intervention.
  
  
  METHODS
  We identified patients who received naloxone to reverse opioid-induced respiratory depression or sedation within 48 hours after discharge from anesthetic care (transfer from the postanesthesia care unit or transfer from the operating room to postoperative areas) between July 1, 2008, and June 30, 2010. Patients were matched to 2 control subjects based on age, sex, and exact type of procedure performed during the same year. A chart review was performed to identify patient, anesthetic, and surgical factors that may be associated with risk for intervention requiring naloxone. In addition, we identified all patients who developed adverse respiratory events (hypoventilation, apnea, oxyhemoglobin desaturation, pain/sedation mismatch) during phase 1 anesthesia recovery. We performed conditional logistic regression taking into account the 1:2 matched set case-control study design to assess patient and procedural characteristics associated with naloxone use.
  
  
  RESULTS
  We identified 134 naloxone administrations, 58% within 12 hours of discharge from anesthesia care, with an incidence of 1.6 per 1000 (95% confidence interval [CI], 1.3-1.9) anesthetics. The presence of obstructive sleep apnea (odds ratio [OR] = 2.45; 95% CI, 1.27-4.66; P = 0.008) and diagnosis of an adverse respiratory event in the postanesthesia recovery room (OR = 5.11; 95% CI, 2.32-11.27; P < 0.001) were associated with an increased risk for requiring naloxone to treat respiratory depression or sedation after discharge from anesthesia care. After discharge from anesthesia care, patients administered naloxone used a greater median dose of opioids (10 [interquartile range, 0-47.1] vs 5 [0-24.8] IV morphine equivalents, P = 0.020) and more medications with sedating side effects (n = 41 [31%] vs 24 [9%]; P < 0.001).
  
  
  CONCLUSIONS
  Obstructive sleep apnea and adverse respiratory events in the recovery room are harbingers of increased risk for respiratory depression or sedation requiring naloxone after discharge from anesthesia care. Also, patients administered naloxone received more opioids and other sedating medications after discharge from anesthetic care. Our findings suggest that these patients may benefit from more careful monitoring after being discharged from anesthesia care.
authors.affiliation: From the *Department of Anesthesiology, †Nursing Thoracic/Vascular ICU and Mayo School of Health Sciences, ‡Mayo School of Health Sciences, §Nursing Pediatric ICU and Mayo School of Health Sciences, and ∥Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.forename: Vitaly
authors.initials: V
authors.lastname: Herasevich
authors.forename: Maria C
authors.initials: MC
authors.lastname: McGlinch
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Beatty
authors.forename: Erin D
authors.initials: ED
authors.lastname: Christensen
authors.forename: Susan K
authors.initials: SK
authors.lastname: Hannifan
authors.forename: Amy E
authors.initials: AE
authors.lastname: Koenig
authors.forename: Justin
authors.initials: J
authors.lastname: Klanke
authors.forename: Xun
authors.initials: X
authors.lastname: Zhu
authors.forename: Bhargavi
authors.initials: B
authors.lastname: Gali
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003243:Consciousness / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D016015:Logistic Models; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009270:Naloxone / Q000008:administration & dosage* / Q000009:adverse effects; D009292:Narcotic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D016017:Odds Ratio; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone