Predictors of naloxone use for respiratory depression and oversedation in hospitalized adults

Abstract

Hospitalized patients on general medical units who required naloxone to reverse opioid-induced oversedation or respiratory depression had significantly more risk factors than matched patients who did not require naloxone.

Improving the Safety of Opioid Use for Acute Noncancer Pain in Hospitalized Adults: A Consensus Statement From the Society of Hospital Medicine

“…1,18,19 While benzodiazepines have received the most attention in this respect, other medications with central nervous system depressant properties may also increase risk, including but not limited to non-benzodiazepine sedative-hypnotics (e.g., zolpidem, zaleplon, zopiclone), muscle relaxants, sedating anti-depressants, antipsychotics, and antihistamines. 18,19,46 For some patients, the combination will be unavoidable, and we do not suggest routine discontinuation of longstanding medications that pre-existed hospitalization given the risks of withdrawal and/or worsening of the underlying condition for which these medications are prescribed. Rather, clinicians should carefully consider the necessity of each medication class with input from the patient’s outpatient providers, taper the frequency and/or dose of CNS depressants when appropriate and feasible, and avoid new co-prescriptions to the extent possible, both during hospitalization and on hospital discharge.…”

Findings of a Naloxone Database and its Utilization to Improve Safety and Education in a Tertiary Care Medical Center

“…Naloxone is the available antidote for overdose and reverses signs of opioid intoxication, especially when administered via the parenteral route . In 2014, Pawasauskas et al., looked at naloxone use to identify the risk factors for opioid‐induced respiratory depression and other studies, including Gordon et al., and Ekstrand et al., which demonstrated its utility as a quality indicator.…”

American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions

“…Rationale. Several cohort studies have documented risk factors for opioid-related adverse events and the need for naloxone rescue (Khelemsky, Kothari, Campbell, & Farnad, 2015;Lee et al, 2015;Pawasauskas, Stevens, Youssef, & Kelley, 2014;Rosenfeld et al, 2016;Weingarten, Herasevich, et al, 2015;Weingarten, Warner, & Sprung, 2017). Please see Table 2 for a list of evidence-based patient risk factors.…”

“…ASA classification (Category B). When more than one comorbid condition exists, the likelihood of developing postoperative complication such as OIUAS and OIRD is increased (Fernandez-Bustamante et al, 2017;Gupta et al, 2018;Khelemsky et al, 2015;Lee et al, 2015;Pawasauskas et al, 2014;Rosenfeld et al, 2016;Schug, Palmer, Scott, Halliwell, & Trinca, 2016). For 50 years, anesthesia providers have used the American Society of Anesthesiologists (ASA) Physical Status Classifications system to rate a patient's risk of undergoing anesthesia (Hurwitz et al, 2017).…”

“…Specific diseases (Category B). There is strong evidence supporting the use of the ASA classification score as a predictor of risk for OIUAS and OIRD (Fernandez-Bustamante et al, 2017;Nadpara, Joyce, Carroll, Carroll, Barnard, & Zedler, 2018;Pawasauskas et al, 2014;Ramachandran et al, 2017;Weingarten et al, 2016;Yung, Lee, Hsu, Furnish, & Atayee, 2017;Zedler, Saunders, Joyce, Vick, & Murrelle, 2018). Additionally, there is substantial evidence to indicate that patients with diabetes mellitus (Fernandez-Bustamante et al, 2017;Gupta et al, 2018;Nadpara et al, 2018;Ramachandran et al, 2017;Weingarten et al, 2016;Zedler et al, 2018), renal impairment (Dahan, Overdyk, Smith, Aarts, & Niesters, 2013;Fernandez-Bustamante et al, 2017;Khanna et al, 2019;Nadpara et al, 2018;Pawasauskas et al, 2014;Yung et al, 2017;Zedler et al, 2018), and heart failure (Khanna et al, 2019;Nadpara et al, 2018;Pawasauskas et al, 2014;Ramachandran et al, 2017;Yung et al, 2017;Zedler et al, 2018) could be at high risk for OIUAS and OIRD.…”