Articles  |   May 2013
Factors Associated With Postoperative Respiratory Depression: From the ASA Closed Claims Analysis
Author Affiliations
  • Lorri A. Lee, M.D.
    ASA Closed Cliams Project
    Member
  • Karen B. Domino, M.D., M.P.H.
    Committee on Professional Liability
    Chair
Article Information
Pain Medicine / Respiratory System / Articles
Articles   |   May 2013
Factors Associated With Postoperative Respiratory Depression: From the ASA Closed Claims Analysis
ASA Monitor 05 2013, Vol.77, 34-36.
ASA Monitor 05 2013, Vol.77, 34-36.
Postoperative respiratory depression (RD) from opioids remains a significant cause of high-severity injuries for patients, often resulting in death or brain damage. The Joint Commission recently issued Sentinel Event Alert Issue 49 regarding the safe use of opioids after review of opioid- related events from the Joint Commission’s Sentinel Event Database from 2004-11.1  Wrong-dose medication errors were present in 47 percent of these sentinel events, improper monitoring occurred in 29 percent, and other factors such as excessive dosing, medication interactions and adverse drug effects were present in 11 percent.1 
Over the past five to six years, both the Institute for Safe Medication Practices2  and the Anesthesia Patient Safety Foundation3  have advocated for increased monitoring (electronic and nursing assessments) of patients receiving opioids in the postoperative period. Together with the Joint Commission, these organizations emphasize the superiority of continuous electronic monitoring over spot checks with pulse oximetry and/or capnography for detection of respiratory depression. However, disagreement exists on whether to monitor all postoperative patients receiving opioids or only those patients perceived to be at high risk for respiratory depression from coexisting conditions such as obesity, obstructive sleep apnea, advanced age, organ system dysfunction, preoperative opioid tolerance or co-administration of non-opioid sedating medications.
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