Opioid Safety, Respiratory Compromise

Should all patients after surgery be monitored?

by Michael Wong

Do you think that all patients after surgery should be monitored?

In the recent survey on ASA Standards and APSF Recommendations, 90% said “YES” (agreed) that “continuous electronic monitoring of oxygenation and ventilation should be available and considered for all patients”. This monitoring “would reduce the likelihood of unrecognized clinically significant opioid-induced depression of ventilation in the postoperative period.”

But, 10% said “NO” (disagreed).

Dr. Marc Popovich (Medical Director, Surgical Intensive Care Unit at Cleveland Clinic) expresses surprise over these results. “I am quite shocked that the disagree group is that high! The question asked whether continuous monitoring should be ‘available and considered’ for all patients. What this survey result is saying is that 10% do not have monitoring available and it is not even being considered for their patients after surgery.”

To improve patient safety and health outcomes, the Anesthesia Patient Safety Foundation (APSF) recently released recommendations calling for continuous electronic monitoring of oxygenation and ventilation. For a link to APSF recommendations and expert commentary on them, please click here.

“This electronic monitoring,” explains Dr. Popovich, “would entail the use of pulse oximetry which measures the amount of oxygen in the blood and capnograph which measures the concentration of carbon dioxide that a person breathes out in exhaled air.”

Moreover, as Dr. Moises Auron (Department of Hospital Medicine and the Center for Pediatric Hospital Medicine at the Cleveland Clinic) says, “This intervention is easy. Simply clamp on the pulse oximeter and hook up the capnograph.”

Unfortunately, this easy process is not being done all the time and patient safety may be compromised.

“I get too many calls from patients whose family members have died from post-op opiate overdose,” says Helen Haskell, who is a co-founder of The Empowered Patient Coalition, whose mission is to “allow patients and their advocates to assume a greater role in improving the safety and the quality of their health care”.

“From a patient’s point of view, this sort of error is incomprehensible, because it is so fundamental.  People should be able to assume that basic safety precautions have been taken when they are in the hospital,” says Ms. Haskell.

What do you think?

2 thoughts on “Should all patients after surgery be monitored?

  1. The progress in medicine should be working for safer conditions for patients. Ventilation and oxygenation electronic monitoring it´s easy as Dr Auron said. The problems I can foresee in the adoption and implementation of new routines are:
    1.- The normal reluctancy to change in any institution or consolidated team
    2.- The laziness to document, justify and lobby about new practices, and also the recognition that we can do better.
    3.- The lack of proper equipment, as still happens in not so few hospitals in the mid developed world, which does not have possibility of measuring capnography or have enough pulsioximeters for all post-operated patients.
    I definitively support better practices which can produce safer outcomes, even more when in many cases only needs of new agreed attitudes and/or protocols.

  2. Dr. Sonia Saini provided this comment on the poll:
    Absolutely! I think all patients after surgery should be monitored with atleast basic ASA standard monitors. I am shocked to see 10% providers disagree with this, perhaps they are not directly involved with patient care or just plain naive. We need to raise more awareness about these issues.

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