Caution with epidural opioid use in sleep apnea patients.

摘要

Sleep apnea patients are prone to developing respiratory depression with the use of opioids. Over the last 10 years in our institution we have observed an increase in respiratory depression manifesting as CO_2 retention and/or an increase in the duration of apneic episodes in patients with sleep apnea who are receiving epidural opioids. In most of these cases, the sleep apnea was missed or undiagnosed preoperatively. The ASA has established detailed guidelines with regard to the perio-perative management of sleep apnea patients [1,2]. These include the recommendation of avoidance of neuraxial opioids in this patient population. However, this diagnosis can be overlooked during preoperative screening. This may be a result of the fact that the patient does not fit the classic profile or they reply negatively to the screening questions because they are unaware of their symptoms.