Author: Farney RJ et al.
Anesthesia & Analgesia 141(3):507–515, September 2025. doi:10.1213/ANE.0000000000007124
This prospective study investigated ataxic breathing (AB) as an underrecognized marker of opioid-induced respiratory depression (OIRD). Twenty-six healthy volunteers received escalating remifentanil doses with light propofol sedation. Respiratory rate was measured via inductance plethysmography, sedation by MOAA/S, and AB severity using a support vector machine model applied to Poincaré plot features.
Across 121 steady-state assessments, AB demonstrated high sensitivity (92%) but low specificity (28%) for detecting OIRD as defined by standard criteria (bradypnea <8/min or MOAA/S <4). Notably, in 72% of cases not classified as OIRD by conventional measures, moderate or severe AB was present.
The findings suggest that AB occurs frequently in the absence of bradypnea or overt sedation, indicating it may serve as an early or additive marker for opioid-related respiratory risk. Future studies should assess generalizability across other opioids and clinical settings to determine whether incorporating AB monitoring improves patient safety.
What You Should Know
• Ataxic breathing is a common but overlooked manifestation of opioid effects.
• In this study, AB had high sensitivity (92%) but poor specificity (28%) for OIRD.
• AB often appeared without bradypnea or sedation, suggesting current monitoring may miss early risk.
• Machine-learning tools enhanced detection of AB patterns.
• Further validation with other opioids and real-world clinical use is needed before routine adoption.
Thank you to Anesthesia & Analgesia for making this work available.