Postoperative respiratory depression

Postoperative Respiratory Depression

Postoperative respiratory depression is a serious medical condition which occurs as a complication after surgery. It is caused by a combination of drugs used during and right after surgery, particularly opioid analgesics such as morphine, fentanyl and fentanyl derivatives. It is characterized by a decrease in rate and depth of breathing, and can have a wide range of severity.

This condition can result in decreased oxygen to the body's vital organs, leading to confusion, lethargy, coma and even death. It also has the potential to disrupt the control of cardiopulmonary and autonomic functions essential for maintaining homeostasis and organ perfusion.

Early recognition of the condition is key in reducing its mortality rate. Several preoperative conditions can make a patient more susceptible to postoperative respiratory depression, such as:

Age older than 65
Sleep apnea
Obesity
ARDS (acute respiratory distress syndrome)
Depression
Anxiety
Hypothyroidism

During surgery, there are a number of watch-signs that can help detect the condition. These include:

Hypo- or hyper-ventilation
Hypoxia
Sleepiness or confusion
Decreased breath sounds
Head and eye deviations
Low oxygen saturation levels
Abnormal vital signs

Appropriate management of postoperative respiratory depression can prevent long-term physical and psychological disability. Treatment starts with immediate cessation of opioid administration, followed by oxygen therapy, mechanical ventilation if needed and by administration of reversal agents such as naloxone.

Postoperative respiratory depression is a life-threatening condition that can be prevented if properly identified. It is critical for medical professionals to be aware of the risks, symptoms and management options available.