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Respiratory depression linked to opioids
As a growing body of evidence suggests that aggressive treatment of pain, by intravenous or neuraxial opioids, might be associated with respiratory depression, the American Society of Anesthesiologists has released updated Practice Guidelines for the Prevention, Detection and Management of Respiratory Depression Associated with Neuraxial Opioid Administration.
The updated practice guidelines include new survey data and recommendations pertaining to monitoring for respiratory depression. "As more patients seek treatment for acute and chronic pain, it is important that physicians recognize and manage possible adverse effects of these pain treatments, including the serious occurrence of respiratory depression," said Terese T. Horlocker, MD, chair of the American Society of Anesthesiologists Task Force on Neuraxial Opioids.
Focused on the treatment of all patients receiving epidural or spinal administration of opioids in ambulatory or inpatient settings, the guidelines are outlined in four key areas with specific treatment recommendations:
Identification of patients at increased risk of respiratory depression, including recommendations for focused history and physical examination.
Prevention of respiratory depression after neuraxial opioid administration, including recommendations for noninvasive positive pressure ventilation, drug selection, and dose selection.
Detection of respiratory depression and management, including recommendations for patient monitoring for adequacy of ventilation, oxygenation, and level of consciousness.
Management and treatment of respiratory depression, including recommendations for supplemental oxygen, reversal agents, and noninvasive positive pressure ventilation to improve respiratory rate and reduce adverse outcomes.
The updated guidelines can be found in the February 2009 issue of Anesthesiology. Copies of the guidelines can be found on the web site www.anesthesiology.org.