Authors: Davide Cattano, MD, PhD, FASA et al
Opioid-induced respiratory depression (OIRD) has been recognized as one of the most dramatic and serious complications from the perioperative use of opioid analgesics. Current international efforts to publicize to the lay public the potential effects of misusing opioids, such as the risk for addiction, have had a surprising effect on clinical practice by favoring the development of multimodal analgesic strategies designed to reduce, or sometimes avoid altogether, the use of opioids.1
However, a second and more important factor deserves attention: airway obstruction. Airway obstruction is of great concern in the perioperative period: Patients’ sensitivity to opioids7 may still be observed in a dangerous scenario in which patients experience respiratory depression and ventilatory insufficiency (residual paralysis, atelectasis, splinting, positioning, body habitus). Therefore, we want to stress that, while opioids per se may not necessarily have a greater effect in obese patients or those with OSA, the increased risks for airway obstruction in these patients still call for greater caution and demand an increased level of monitoring, with a meticulous, clinical approach.
A recent update from the Society of Anesthesia and Sleep Medicine’s task force issued practice management guidelines8 to increase awareness that OSA may coexist with and be a complicating factor of OIRD, thus not predisposing but a comorbidity. An effective best practice remains vigilance and appropriate monitoring while we continue to identify which factors will predict patients at risk.