Canadian Journal of Anaesthesia

, 41:125

Respiratory depression associated with patient-controlled analgesia: a review of eight cases

  • Richard C. Etches
Clinical Reports

Abstract

Patient-controlled iv delivery of opioids for postoperative pain management is a popular alternative to the traditional im route of administration. However, occasional patients receiving opioids in this manner develop severe respiratory depression. The purpose of this paper is to determine the incidence of, and factors contributing to, the development of this complication. To do this, the Office of Medical Quality Improvement retrospectively searched for reports of respiratory depression in a database compiled from the charts of approximately 1600 patients who had received PCA at the University of Alberta Hospitals in 1992. Eight cases of serious respiratory depression were detected. Factors associated with the occurrence of respiratory depression included the concurrent use of a back-ground infusion, advanced age, concomitant administration of sedative/hypnotic medications, and pre-existing sleep apnoea syndrome. No cases were attributed to operator error or equipment malfunction. In conclusion, the risk of respiratory depression with patient-controlled opioid administration is similar to that observed when opioids are delivered by the traditional im or spinal routes. The safe and effective use of patient-controlled analgesia depends upon knowledgeable medical and nursing staff, clearly defined nursing policy and procedures, and frequent patient follow-up.

Key words

Pain: postoperative Analgesia: patient-controlled Complications: respiratory depression 

Résumé

L’administration contrôlée par le patient (PCA) de morphiniques iv pour le traitement de la douleur postopératoire est une alternative valable à la voie im traditionnelle. Cependant, à l’occasion, des malades sous morphiniques administrés de cette façon souffrent de dépression respiratoire grave. Cette étude vise à déterminer son incidence et les facteurs qui contribuent à l’apparition de cette complication. Avec cet objectif en vue, le bureau médical de l’amélioration de la qualité a recherché rétrospectivement les cas de dépression respiratoire dans une banque de données compilées à partir des dossiers de 1600 patients traités par PCA dans les hôpitaux de l’université de l’Alberta en 1992. On a retracé huit cas de dépression respiratoire grave. Les facteurs associés avec la survenue de cette dépression comprenaient l’administration concomitante d’une perfusion continue ou de sédatifs, la vieillesse et la préexistence du syndrome d’apnée du sommeil. Des erreurs humaines ou instrumentales n’ont jamais été mises en cause. Pour conclure, le risque d’une dépression respiratoire avec la PCA morphinique est le même que celui qu’on retrouve avec les morphiniques im ou rachidiens. La sécurité et l’efficacité de l’analgésie autocontrôlée dépend d’un personnel soignant et médical avisé, de politiques et protocoles bien établis et d’une surveillance étroite.

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Copyright information

© Canadian Anesthesiologists 1994

Authors and Affiliations

  • Richard C. Etches
    • 1
  1. 1.Department of AnaesthesiaUniversity of Alberta Hospitals, University of AlbertaEdmonton

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