Postop opioid-induced respiratory distress most common in first 12 hours

  • Gupta K & al.
  • BMJ Open
  • 14 Dec 2018

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • The risk of postoperative opioid-induced respiratory depression (OIRD) is significantly higher in surgical patients with coexisting cardiac disease, pulmonary disease, or obstructive sleep apnea (OSA).
  • 80% of postoperative OIRD cases occurred within 12 hours after surgery.

Why this matters

  • OIRD is the major cause of opioid-related death and is the most serious complication from postoperative pain management with opioids.
  • This is the first meta-analysis to identify risk factors associated with OIRD in surgical patients.

Study design

  • This systematic review and meta-analysis identified 12 observational studies that evaluated adult patients (aged, ≥18 years) who were administered opioids after surgery.
  • Funding: None disclosed.

Key results

  • 4194 patients (0.5%) out of 841,424 surgical patients developed postoperative OIRD (incidence, 5.0 cases/1000 anesthetics delivered; 95% CI, 4.83-5.14).
  • Among postoperative OIRD events, 80% occurred within first 12 hours and 85% within first 24 hours.
  • Risk for postoperative OIRD was higher in patients with coexisting:
    • cardiac disease (OR, 1.79; P<.002 i>2, 0%),
    • pulmonary disease (OR, 2.27; P<.001 i>2, 0%), and
    • OSA (OR, 1.4; P=.0003; I2, 31%).

Limitations

  • Mild cases of OIRD may not be reported, leading to measurement bias.
  • Heterogeneity among included studies.

Coauthored with Antara Ghosh, PhD

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