Alarm Fatigue, Respiratory Compromise

The Risk of Opioids in Post-Surgical Settings

This is the fourth article in a series exploring the impact of pulse oximetry alarm thresholds in hospitalized patients.

By J. Paul Curry, MD (anesthesiologist)

In the first article, “Improving the Safety of Post-Surgical Care,” I introduced the concept that, although the current approach to physiologic threshold monitoring (triggering an alarm when oxygen saturation falls below 90%) works well in the OR, it is unreliable on post-surgical floors.

Image source: http://thedoctorweighsin.com/the-risk-of-opioids-in-post-surgical-settings/

Image source: http://thedoctorweighsin.com/the-risk-of-opioids-in-post-surgical-settings/

In the second post, “Pulse Oximetry False Alarms on Post-Surgical Floors,” I explored in more depth why the threshold for triggering a pulse oximetry alarm should vary depending on the site of care (OR vs post-surgical floor). The key to appreciating why this is the case is understanding that the clinical conditions that threaten oxygenation on post-surgical floors are different from the type of sudden, life-threatening airway compromise that occur in ORs. Those conditions often have an insidious onset and comprise sepsis, aspiration, congestive heart failure, pulmonary embolus, and two different types of opioid-associated respiratory depression.

In third post, “Detecting Deadly Post-Surgical Respiratory Dysfunction,” I reviewed the pattern of respiratory compromise that characterizes the conditions not related to opioid use. In this post, I will discuss the respiratory risk of opioids in post-surgical settings.

To read a complete copy of this article, please click here.

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