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Preventing complications in patients receiving opioids

Unrecognized respiratory depression on the general medical units, culminating in respiratory arrest or “code blue” is a nightly occurrence at hospitals across the U.S.. A significant portion of these respiratory arrests occur in postoperative patients receiving opioid analgesics and sedatives, which contribute to respiratory depression. Failure to recognize respiratory depression and institute timely resuscitation has led to cardiopulmonary arrest, resulting in anoxic brain injuries and deaths.

Monitoring patients receiving opioids
Routine monitoring of vital signs may fail to detect early signs of respiratory depression. Many nurses focus on pulse oximetry, blood pressure, and respiratory rate when assessing a patient for opioid-related oversedation. But pulse oximetry also may not provide accurate information, especially in a patient receiving oxygen. Also, bradypnea is a poor predictor of oxygen desaturation and occur late in respiratory depression—or not at all. In opioid-naïve patients, respiratory rate is a notoriously poor predictor of respiratory depression; it may be normal despite significant hypoventilation. Also be aware that the patient’s respiratory status may change rapidly, and these changes may elude conventional monitoring techniques used in most settings today.
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Disclaimer: While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer.For specific technical or legal advice on the information provided and related topics, please contact the author.

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