Journal of Anesthesia

, Volume 30, Issue 1, pp 116–122 | Cite as

Predictors and outcomes following naloxone administration during Phase I anesthesia recovery

  • Toby N. WeingartenEmail author
  • Elisa Y. Chong
  • Darrell R. Schroeder
  • Juraj Sprung
Original Article



To identify characteristics associated with postoperative respiratory depression that required naloxone intervention during Phase I recovery following general anesthesia. A secondary aim is to compare postoperative outcomes between patients who received naloxone and those who did not.


Patients who received naloxone to reverse opioid-induced respiratory depression or sedation during Phase I postanesthesia recovery from January 1, 2010 to December 31, 2013 were identified and matched to 2 controls based on age, sex, and surgical procedure during the same year. A chart review was performed to identify factors associated with risk for intervention requiring naloxone as well as to note the occurrence of adverse postoperative outcomes. Analyses to assess characteristics potentially associated with naloxone use were performed using conditional logistic regression taking into account the 1:2 matched set case–control study design.


Naloxone was administered to 413 patients, with an incidence of 2.5 per 1000 anesthetics [95 % confidence interval (CI) 0.7–6.5]. Presence of obstructive sleep apnea [odds ratio (OR) = 1.74, 95 % CI 1.22–2.48, P = 0.002], ASA Physical Status (PS) ≥III (OR 1.44, 95 % CI 1.08–1.92, P = 0.013), and greater opioid administration (OR 1.22, 95 % CI 1.12–1.33, per 10 intravenous morphine equivalents mg, P < 0.001) were associated with naloxone administration. Naloxone administration was associated with increased adverse events (OR 3.39, 95 % CI 2.22–5.23, P < 0.001).


Obstructive sleep apnea, higher ASA-PS scores and greater doses of intraoperative opioids were associated with naloxone administration during Phase I recovery. Patients administered naloxone had increased adverse events after discharge from the recovery room and may benefit from a higher level of postoperative care.


Naloxone Postoperative complications 

Supplementary material

540_2015_2082_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 18 kb)


  1. 1.
    Phillips DM. JCAHO pain management standards are unveiled. Joint Commission on Accreditation of Healthcare Organizations. JAMA. 2000;284:428–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Frasco PE, Sprung J, Trentman TL. The impact of the joint commission for accreditation of healthcare organizations pain initiative on perioperative opiate consumption and recovery room length of stay. Anesth Analg. 2005;100:162–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Medication Safety Alert Pain scales don’t weight every risk. Huntington Valley: Institute of Safe Medications Practices; 2002.Google Scholar
  4. 4.
    Vila H Jr, Smith RA, Augustyniak MJ, Nagi PA, Soto RG, Ross TW, Cantor AB, Strickland JM, Miguel RV. The efficacy and safety of pain management before and after implementation of hospital-wide pain management standards: is patient safety compromised by treatment based solely on numerical pain ratings? Anesth Analg. 2005;101:474–80.CrossRefPubMedGoogle Scholar
  5. 5.
    Gordon DB, Pellino TA. Incidence and characteristics of naloxone use in postoperative pain management: a critical examination of naloxone use as a potential quality measure. Pain Manag Nurs. 2005;6:30–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Ramachandran SK, Haider N, Saran KA, Mathis M, Kim J, Morris M, O’Reilly M. Life-threatening critical respiratory events: a retrospective study of postoperative patients found unresponsive during analgesic therapy. J Clin Anesth. 2011;23:207–13.CrossRefPubMedGoogle Scholar
  7. 7.
    Taylor S, Kirton OC, Staff I, Kozol RA. Postoperative day one: a high risk period for respiratory events. Am J Surg. 2005;190:752–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Weingarten TN, Herasevich V, McGlinch MC, Beatty NC, Christensen ED, Hannifan SK, Koenig AE, Klanke J, Zhu X, Gali B, Schroeder DR, Sprung J. Predictors of delayed postoperative respiratory depression assessed from naloxone administration. Anesth Analg. 2015;121:422–9.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Dahan A, Aarts L, Smith TW. Incidence, reversal, and prevention of opioid-induced respiratory depression. Anesthesiology. 2010;112:226–38.CrossRefPubMedGoogle Scholar
  10. 10.
    Sarton E, Teppema L, Dahan A. Naloxone reversal of opioid-induced respiratory depression with special emphasis on the partial agonist/antagonist buprenorphine. Adv Exp Med Biol. 2008;605:486–91.CrossRefPubMedGoogle Scholar
  11. 11.
    Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg. 1970;49:924–34.PubMedGoogle Scholar
  12. 12.
    Gali B, Whalen FX Jr, Gay PC, Olson EJ, Schroeder DR, Plevak DJ, Morgenthaler TI. Management plan to reduce risks in perioperative care of patients with presumed obstructive sleep apnea syndrome. J Clin Sleep Med. 2007;3:582–8.PubMedCentralPubMedGoogle Scholar
  13. 13.
    Gali B, Whalen FX, Schroeder DR, Gay PC, Plevak DJ. Identification of patients at risk for postoperative respiratory complications using a preoperative obstructive sleep apnea screening tool and postanesthesia care assessment. Anesthesiology. 2009;110:869–77.CrossRefPubMedGoogle Scholar
  14. 14.
    Flemons WW. Clinical practice. Obstructive sleep apnea. N Engl J Med. 2002;347:498–504.CrossRefPubMedGoogle Scholar
  15. 15.
    Management of Cancer Pain; Clinical Practice Guideline Number 9. In: AHCPR publication no. 94-0592. US Dept. of Health and Human Services; 1994.Google Scholar
  16. 16.
    Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain, 4th ed. Skokie: American Pain Society; 1999.Google Scholar
  17. 17.
    Weingarten TN, Venus SJ, Whalen FX, Lyne BJ, Tempel HA, Wilczewski SA, Narr BJ, Martin DP, Schroeder DR, Sprung J. Postoperative emergency response team activation at a large tertiary medical center. Mayo Clin Proc. 2012;87:41–9.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Oderda GM, Said Q, Evans RS, Stoddard GJ, Lloyd J, Jackson K, Rublee D, Samore MH. Opioid-related adverse drug events in surgical hospitalizations: impact on costs and length of stay. Ann Pharmacother. 2007;41:400–6.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2015

Authors and Affiliations

  • Toby N. Weingarten
    • 1
    Email author
  • Elisa Y. Chong
    • 2
  • Darrell R. Schroeder
    • 3
  • Juraj Sprung
    • 4
  1. 1.Department of Anesthesiology, Mayo Clinic College of MedicineMayo ClinicRochesterUSA
  2. 2.Mayo Clinic Medical Student, Mayo Clinic College of Medicine, Mayo Medical SchoolMayo ClinicRochesterUSA
  3. 3.Mayo Clinic College of Medicine, Biomedical Statistics and InformaticsMayo ClinicRochesterUSA
  4. 4.Department of Anesthesiology, Mayo Clinic College of MedicineMayo ClinicRochesterUSA

Personalised recommendations