(From the May issue of: SOCCA Interchange)
Beyond the PACU, before the ICU
Summary of the Respiratory Depression: Beyond the PACU, before the ICU written by: Ashish K. Khanna, MD Staff Intensivist and Anesthesiologist, Assistant Professor of Anesthesiology, Center for Critical Care and Departments of General Anesthesiology and OUTCOMES RESEARCH, Anesthesiology Institute, Cleveland Clinic is summarized by John Zaleski
The Medscape article, “Respiratory Depression in the Postoperative Period” by Khanna et al. describes the challenges faced in managing patients receiving postoperative opioids, particularly on the general care floor where continuous monitoring has not traditionally been the norm.
The occurrence of hypoxemia beyond PACU and outside of ICU is a common and persistent one and goes largely undetected. Furthermore, neither the STOP-BANG score nor the use of long-term opioids seem to herald the onset and detection of hypoxemia postoperatively.
The general recommendation is that continuous monitoring, particularly pulse oximetry and capnography, but measurements of arterial oxygen saturation, respiratory rate, and blood pressure should be part of a continuous monitoring protocol in all general care floor patients in order to provide early identification of the onset of respiratory depression.