Opioid‐induced ventilatory impairment: current ‘track and trigger’ tools need to be updated

Bowen, Jon; Levy, N.; Macintyre, Pamela E.

doi:10.1111/anae.15030

Cited by 5 publications

(13 citation statements)

References 24 publications

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“…These processes, alone or in combination, can lead to severe opioid‐induced ventilatory impairment which, if unrecognised and untreated, may result in brain injury or death [78]. As depression of the respiratory centre is only one component of this triad, opioid‐induced ventilatory impairment is a more appropriate term than opioid‐induced respiratory depression [18].…”

Section: Opioid‐induced Ventilatory Impairmentmentioning

confidence: 99%

“…This appears to be primarily a result of increased brain sensitivity to opioids rather than age‐related changes in pharmacokinetics, which are usually not of the magnitude needed to account for the up to four‐fold difference between younger and older patient groups [96]. Initial opioid doses should, therefore, be based on patient age and not weight, as older patients require lower doses to achieve analgesia and also to develop opioid‐induced ventilatory impairment [18].…”

Section: Reducing the Risk: Recommendations And Rationalementioning

confidence: 99%

“…As routine measurement of arterial partial pressures of carbon dioxide is not possible, investigators usually define opioid-induced ventilatory impairment using surrogate measures that include respiratory rate (often arbitrarily defined as < 8 or 10 breaths.min À1 ); peripheral oxygen saturation; level of sedation; and rates of naloxone administration. Unfortunately, good evidence showing a reliable correlation between these measures and arterial partial pressures of carbon dioxide is lacking [18]. Thus, the reported incidence of postoperative opioidinduced ventilatory impairment is difficult to determine.…”

Section: Opioid-induced Ventilatory Impairmentmentioning

confidence: 99%

“…It is known that age is a better predictor of opioid requirements than patient weight, with requirements decreasing as age increases [18,95]. This appears to be primarily a result of increased brain sensitivity to opioids rather than age-related changes in pharmacokinetics, which are usually not of the magnitude needed to account for the up to four-fold difference between younger and older patient groups [96].…”

Section: Age-adjusted Opioid Dosingmentioning

confidence: 99%

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An international multidisciplinary consensus statement on the prevention of opioid‐related harm in adult surgical patients

et al. 2020

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Summary This international multidisciplinary consensus statement was developed to provide balanced guidance on the safe peri‐operative use of opioids in adults. An international panel of healthcare professionals evaluated the literature relating to postoperative opioid‐related harm, including persistent postoperative opioid use; opioid‐induced ventilatory impairment; non‐medical opioid use; opioid diversion and dependence; and driving under the influence of prescription opioids. Recommended strategies to reduce harm include pre‐operative assessment of the risk of persistent postoperative opioid use; use of an assessment of patient function rather than unidimensional pain scores alone to guide adequacy of analgesia; avoidance of long‐acting (modified‐release and transdermal patches) opioid formulations and combination analgesics; limiting the number of tablets prescribed at discharge; providing deprescribing advice; avoidance of automatic prescription refills; safe disposal of unused medicines; reducing the risk of opioid diversion; and better education of healthcare professionals, patients and carers. This consensus statement provides a framework for better prescribing practices that could help reduce the risk of postoperative opioid‐related harm in adults.

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Section: Opioid‐induced Ventilatory Impairmentmentioning

confidence: 99%

Section: Reducing the Risk: Recommendations And Rationalementioning

confidence: 99%

Section: Opioid-induced Ventilatory Impairmentmentioning

confidence: 99%

Section: Age-adjusted Opioid Dosingmentioning

confidence: 99%

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An international multidisciplinary consensus statement on the prevention of opioid‐related harm in adult surgical patients

et al. 2020

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“…Therefore, a low concentration of opioids can be administered via the continuous channel with a full volume of 100 mL to maintain the minimum effective analgesic concentration, and other the selector-bolus channel is filled with relatively higher concertation opioids with a half volume of 50 mL for acute phase pain control during the first 24 h postoperatively. This method may also prevent periods of more than the optimal plasma drug concentration resulting in opioid-induced ventilatory impairment (Bowen et al 2020 ; Grass 2005 ) in the late phase after surgery. This disposable PCA can be used in a programmed mode without using microprocessor-driven PCA devices.…”

Section: Discussionmentioning

confidence: 99%

The effect of newly designed dual-channel elastomeric pump for intravenous patient-controlled analgesia after total laparoscopic hysterectomy: a randomized, double-blind, prospective study

Kim

et al. 2022

Perioper Med

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Background A newly designed intravenous patient-controlled analgesia (PCA) device with a dual-channel elastomeric infusion pump has been recently introduced. One channel is a continuous line with a constant flow rate basal infusion, while the other channel has an adjustable flow rate and bolus function and is labeled as a selector-bolus channel. This study compared dual and single-channel intravenous PCA in terms of clinical effect and quality of recovery. Methods Eighty-four patients undergoing total laparoscopic hysterectomy were randomly allocated to a 1-channel group (n = 41) or a 2-channel group (n = 43). Only the selector-bolus channel was utilized, but the continuous channel was not utilized in the 1-channel group, but both channels were utilized in the 2-channel group. In the 1-channel group, 16 μg/kg of fentanyl, 2 mg/kg of ketorolac, and 12 mg of ondansetron with normal saline were administered to the selector-bolus channel and normal saline only in the continuous channel for blinding. In the 2-channel group, 16 μg/kg of fentanyl was administered to the selector-bolus channel, and ketorolac (2 mg/kg) and ondansetron (12 mg) were administered via the continuous channel. The quality of recovery was evaluated preoperatively and 24 h postoperatively using the Quality of Recovery-40 (QoR-40). Cumulative PCA consumption, postoperative pain rated using the numeric rating scale (NRS; during rest/cough), and postoperative nausea were evaluated 6, 12, 24, 36, and 48 h after surgery. Incidence of vomiting and use of antiemetics and rescue analgesics was measured. Results The 24-h postoperative QoR-40 score was higher in the 2-channel group than in the 1-channel group (P=0.031). The incidence of nausea at 12 h and 36 h was significantly higher in the 1-channel group (P=0.043 and 0.040, respectively), and antiemetic use was more frequent in the 1-channel group (P=0.049). Patient satisfaction was higher in the 2-channel group (P=0.036). No significant differences were observed in pain scores during resting/cough or cumulative PCA consumption. Conclusions The 2-channel PCA showed better patient satisfaction with higher QoR-40 during the recovery compared with the 1-channel PCA. Better satisfaction was associated with lower nausea and reduced rescue antiemetics by maintaining the infusion of adjuvant analgesic agents and antiemetic agents constantly by utilizing dual channels. Trial registration Registered at ClinicalTrials.gov, NCT04082039 on 9 September 2019.

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Postoperative pain trajectory and opioid requirements after laparoscopic bariatric surgery: a single-centre historical cohort study

Campbell,

Chin,

Liu

et al. 2024

Can J Anesth/J Can Anesth

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Opioid‐induced ventilatory impairment: current ‘track and trigger’ tools need to be updated

Cited by 5 publications

References 24 publications

An international multidisciplinary consensus statement on the prevention of opioid‐related harm in adult surgical patients

An international multidisciplinary consensus statement on the prevention of opioid‐related harm in adult surgical patients

The effect of newly designed dual-channel elastomeric pump for intravenous patient-controlled analgesia after total laparoscopic hysterectomy: a randomized, double-blind, prospective study

Postoperative pain trajectory and opioid requirements after laparoscopic bariatric surgery: a single-centre historical cohort study

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