Timing of postoperative respiratory emergencies: when do they really occur?
OBJECTIVE
Opioid-induced postoperative respiratory depression has garnered attention and calls for vigilance. However, a higher level of monitoring equates to increased use of hospital resources and is impractical to apply for all postoperative patients. Understanding the temporal pattern of postoperative respiratory emergency occurrences would allow for improved triage of monitoring resources for high-risk patients. Our objective is to describe the temporal pattern of risk of postoperative opioid-induced respiratory failure.


RESULTS
The literature suggests that postoperative opioid-induced respiratory depression is more frequent and severe than previously believed. In response, national patient advocacy groups have proposed improved postoperative monitoring of high-risk patients, especially those with sleep-disordered breathing. Published series of patients who have had adverse respiratory events suggest that the first 24 postsurgical hours comprise the period of highest risk, with most events occurring within the first 12 h. Further, study findings have suggested that adverse respiratory events often occur shortly after administration of opioid analgesics.


CONCLUSIONS
Emerging evidence indicates that the first postsurgical day carries the highest risk of adverse respiratory events, and this risk is often associated with opioid administration. Resources for increased monitoring should be directed to these high-risk times.
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.
Toby N
TN
Weingarten
Lindsay L
LL
Warner
Juraj
J
Sprung
D000328:Adult; D000367:Age Factors; D000701:Analgesics, Opioid / Q000009:adverse effects*; D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods; D002648:Child; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods* / Q000592:standards; D011182:Postoperative Care / Q000379:methods / Q000592:standards; D011183:Postoperative Complications / Q000139:chemically induced / Q000175:diagnosis* / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000175:diagnosis* / Q000453:epidemiology; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013997:Time Factors
D000701:Analgesics, Opioid