Proceedings from the Canadian Society of Respiratory Therapists Annual Education Conference: May 26–28 2016 • Ottawa Ontario

摘要

Opioid-induced respiratory depression, commonly defined as a respiratory rate of less than 8 breaths per minute with a lowered blood oxygen saturation in the context of opioid administration, has been feared since the first days of opioid use in clinics. Mediated by the same μ- receptors responsible for opioid analgesia, this relatively low (0.5%) but highly preventable source of morbidity and mortality is always a risk. While the administration route of the opioid is not related to the incidence of respiratory depression, very potent, long-acting preparations and infusions put the patient at risk, as does the co-administration of certain drugs—especially sedatives or drugs having a significant impact on opioids metabolism through CYP450 or change in renal function. Relatively healthy patients are rarely victims of opioid respiratory depression. However, the “very” patients (very young, very old, very obese and very sick) and patients with sleep apnea, are more susceptible. They should be closely evaluated / monitored to ensure adequate pain control without respiratory depression. In the setting of opioid-induced respiratory depression, one could try non-pharmacological approaches, such as non-opioid pain control (pharmacological or other) and verbal/physical stimuli, while carefully monitoring the patient. Should opioid reversal be needed, naloxone should be given by any trained health professional, in small boluses of 40–100 mcg every 2 minutes, titrated to respiratory drive, not awakening nor pain control.