Features  |   February 2020
The Surgical Patient at Risk for Opioid-induced Ventilatory Impairment
Author Affiliations
  • Brooke E. Trainer, M.D.
    Committee on Patient Safety and Education
  • Richard D. Urman, M.D., M.B.A., FASA
    Chair, Abstract Subcommittee on Patient Safety and Practice Management
Article Information
Pain Medicine / Pharmacology / Features / Opioid
Features   |   February 2020
The Surgical Patient at Risk for Opioid-induced Ventilatory Impairment
ASA Monitor 2 2020, Vol.84, 26-28.
ASA Monitor 2 2020, Vol.84, 26-28.
A substantial number of preventable deaths and adverse events are related to the use of opioids, the most severe being opioid-induced ventilatory impairment (OIVI).1  This is one of the Anesthesia Patient Safety Foundation’s top, ongoing initiatives to ensure that “no patient shall be harmed by opioid-induced respiratory depression in the postoperative period.”2  We know that opioid-related adverse drug events (ORADEs) are associated with increased morbidity and mortality rates. Several coexisting conditions, such as obstructive sleep apnea (OSA), increase a patient’s risk for OIVI. In fact, expert consultants for the ASA Practice Guidelines for the Management of Obstructive Sleep Apnea agree that preprocedure identification of a patient’s OSA status improves perioperative outcomes. Ample evidence exists demonstrating that a patient’s perioperative risk depends on both the severity of the OSA, the invasiveness of the surgical procedure and the need for postoperative opioids.3  Screening, identification and optimization of populations most vulnerable to OIVI may help in the development of strategies to mitigate the risk for this complication.
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