Postoperative opioid-induced respiratory depression or oversedation requiring naloxone treatment in a community hospital: a case series

Abstract

Background

Postoperative opioid-induced respiratory depression and oversedation can lead to fatal events and increase perioperative mortality. In reports from major academic centers, naloxone administration has been used as a proxy for severe opioid overdose. Herein, we studied the incidence, clinical characteristics, and outcomes of postoperative naloxone use in a mid-size community hospital.

Methods

This was a retrospective review of adult patients who received naloxone within 48 postoperative hours between July 9, 2017, and May 31, 2022.

Results

During the study timeframe, a total of 23,362 surgical procedures were performed and a total of 19 patients received naloxone (8 in the recovery room, 11 on hospital wards), with an incidence of 8.1 [95% confidence interval 4.9–12.7] per 10,000 anesthetics. In 12 cases (63%), naloxone was indicated for oversedation, and in 7 cases (37%), for opioid-induced respiratory depression. All patients received naloxone within the first 24 postoperative hours. While all patients survived the opioid-related adverse event, 2 patients were intubated, 1 developed stress-induced cardiomyopathy, and 5 required intensive care unit admission.

Conclusion

The rate of early postoperative opioid-induced respiratory depression or oversedation in our community hospital was low; however, these patients often require a substantial escalation of medical management.

Keywords:

• Naloxone
• opioid toxicity
• oversedation
• respiratory depression

DISCLOSURE STATEMENT

This study was supported by the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin. Toby N. Weingarten receives consulting and speaking fees from Medtronic, Merck. All other authors have no conflicts of interest.

Additional information

Funding

This study was supported by the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin. Toby N. Weingarten receives consulting and speaking fees from Medtronic and Merck.