Opioid-Induced Respiratory Depression in the Acute Care Setting: A Compendium of Case Reports

SUMMARY 

Opioid-induced respiratory depression (OIRD) is a potentially fatal complication of treatment with opioids. Little is known about patient- and case-related factors associated with OIRD. One-hundred-and-five available case reports on OIRD in 134 patients (12 years and older) in the perioperative, obstetric or emergency care setting, published since 1980, were retrieved from the literature. The most frequently reported case-related factors were: morphine use, perioperative setting and obstetrics, neuraxial or intravenous administration. The most frequently reported patient-related factors involved were: female gender, sleep-disordered breathing, obesity, renal impairment, pulmonary disease and CYP450 enzyme polymorphisms. While the analysis has limitations, it confirms that OIRD in the acute setting involves complex and interrelated factors and is a significant cause of preventable morbidity and mortality.

KEYWORDS:

• analgesia
• case report
• case series
• mortality
• opioid-induced respiratory depression
• opioids
• perioperative complications
• respiratory depression

Financial & competing interests disclosure

Since 2010, the LUMC Anesthesia & Pain Research Unit has performed studies on opioid-induced respiratory depression sponsored by Mundipharma Research Ltd (Cambridge, UK) and on reversal of opioid-induced respiratory depression sponsored by Galleon Pharmaceuticals, Inc. (Horsham, PA, USA) and Revive Therapeutics Ltd (Vaughan, ON, Canada). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

Since 2010, the LUMC Anesthesia & Pain Research Unit has performed studies on opioid-induced respiratory depression sponsored by Mundipharma Research Ltd (Cambridge, UK) and on reversal of opioid-induced respiratory depression sponsored by Galleon Pharmaceuticals, Inc. (Horsham, PA, USA) and Revive Therapeutics Ltd (Vaughan, ON, Canada). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.