naloxone and Sleep-Apnea--Obstructive

Noninvasive positive pressure ventilation (NIPPV) may improve postoperative lung function and reduce postoperative complications in patients undergoing abdominal surgery. The purpose of our study was to determine whether the timing of postoperative NIPPV affects lung function 1 day postoperatively.. Forty morbidly obese patients with known obstructive sleep apnea undergoing laparoscopic bariatric surgery with standardized anesthesia care were randomly assigned to receive NIPPV immediately after tracheal extubation (immediate group) or supplemental oxygen (standard group). All patients had continuous positive airway pressure initiated 30 minutes after extubation in the postanesthesia care unit (PACU) via identical noninvasive ventilators. Spirometry was performed by a blinded observer in the perioperative holding area 1 hour after admission to the PACU and 1 day postoperatively. The primary outcome was the change in forced vital capacity (FVC) from baseline to 24 hours (FVC baseline-FVC 24 hours).. Forty patients, 20 in each group, were enrolled in the study. Forced expiratory volume in 1 second, FVC, and peak expiratory flow rate were significantly reduced in both groups from perioperative values throughout the study. At 24 hours, the intervention group had lost only 0.7 L FVC, versus 1.3 L for the intervention group (P = 0.0005). An analysis of covariance confirmed this and indicated that the immediate postoperative NIPPV better preserved spirometric function at 1 and 24 hours postoperatively. Specifically, the differences in the primary outcome were statistically significant.. NIPPV given immediately after extubation significantly improves spirometric lung function at 1 hour and 1 day postoperatively, compared with continuous positive airway pressure started in the PACU, in morbidly obese patients with obstructive sleep apnea undergoing laparoscopic bariatric surgery.

Topics: Adult; Anesthesia, Inhalation; Bariatric Surgery; Critical Care; Female; Heart Arrest; Humans; Intubation, Intratracheal; Laparoscopy; Lung; Male; Middle Aged; Naloxone; Narcotic Antagonists; Obesity, Morbid; Oximetry; Oxygen; Peak Expiratory Flow Rate; Positive-Pressure Respiration; Respiration, Artificial; Respiratory Insufficiency; Sleep Apnea, Obstructive; Spirometry; Treatment Outcome; Vital Capacity

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.

Topics: Aged; Analgesics, Opioid; Anesthesia; Case-Control Studies; Female; Humans; Incidence; Logistic Models; Male; Middle Aged; Naloxone; Postoperative Care; Postoperative Complications; Postoperative Period; Respiratory Insufficiency; Retrospective Studies; Sleep Apnea, Obstructive

The aim of this study was to identify patient and procedural characteristics associated with postoperative respiratory depression or sedation requiring naloxone intervention.. We identified patients who received naloxone to reverse opioid-induced respiratory depression or sedation within 48 hours after discharge from anesthetic care (transfer from the postanesthesia care unit or transfer from the operating room to postoperative areas) between July 1, 2008, and June 30, 2010. Patients were matched to 2 control subjects based on age, sex, and exact type of procedure performed during the same year. A chart review was performed to identify patient, anesthetic, and surgical factors that may be associated with risk for intervention requiring naloxone. In addition, we identified all patients who developed adverse respiratory events (hypoventilation, apnea, oxyhemoglobin desaturation, pain/sedation mismatch) during phase 1 anesthesia recovery. We performed conditional logistic regression taking into account the 1:2 matched set case-control study design to assess patient and procedural characteristics associated with naloxone use.. We identified 134 naloxone administrations, 58% within 12 hours of discharge from anesthesia care, with an incidence of 1.6 per 1000 (95% confidence interval [CI], 1.3-1.9) anesthetics. The presence of obstructive sleep apnea (odds ratio [OR] = 2.45; 95% CI, 1.27-4.66; P = 0.008) and diagnosis of an adverse respiratory event in the postanesthesia recovery room (OR = 5.11; 95% CI, 2.32-11.27; P < 0.001) were associated with an increased risk for requiring naloxone to treat respiratory depression or sedation after discharge from anesthesia care. After discharge from anesthesia care, patients administered naloxone used a greater median dose of opioids (10 [interquartile range, 0-47.1] vs 5 [0-24.8] IV morphine equivalents, P = 0.020) and more medications with sedating side effects (n = 41 [31%] vs 24 [9%]; P < 0.001).. Obstructive sleep apnea and adverse respiratory events in the recovery room are harbingers of increased risk for respiratory depression or sedation requiring naloxone after discharge from anesthesia care. Also, patients administered naloxone received more opioids and other sedating medications after discharge from anesthetic care. Our findings suggest that these patients may benefit from more careful monitoring after being discharged from anesthesia care.

Topics: Aged; Analgesics, Opioid; Chi-Square Distribution; Consciousness; Dose-Response Relationship, Drug; Electronic Health Records; Female; Humans; Logistic Models; Lung; Male; Middle Aged; Multivariate Analysis; Naloxone; Narcotic Antagonists; Odds Ratio; Respiratory Insufficiency; Retrospective Studies; Risk Factors; Sleep Apnea, Obstructive; Time Factors; Treatment Outcome

Topics: Airway Obstruction; Anesthetics, Intravenous; Bradycardia; Cardiotonic Agents; Cholangiopancreatography, Endoscopic Retrograde; Choledocholithiasis; Decerebrate State; Flumazenil; GABA Agonists; Humans; Hypnotics and Sedatives; Hypoxia; Intraoperative Complications; Intubation, Intratracheal; Male; Midazolam; Middle Aged; Naloxone; Piperidines; Propofol; Remifentanil; Sleep Apnea, Obstructive

Naloxone is commonly used to reverse narcotic intoxication. However, its use is not entirely free of hazards. For instance, pulmonary edema (PE) has been reported to arise with the mechanism of over-sympathetic discharge caused by release of cat-echolamine or central neurogenetic responses to narcotic reversal. Here, we report a healthy young patient who, after undergoing an uneventful uvulopalatopharyngo-plasty for obstructive sleep apnea hypopnea syndrome, developed PE following administration of naloxone. Fentanyl-induced respiratory depression was found during anesthesia emergence and thus naloxone was indicated for reversal. Unfortunately, upper airway obstruction-induced negative pressure PE occurred following naloxone administration. From this case, we suggest that a patent airway should be ascertained before naloxone administration for treating narcotic-induced respiratory depression.

Topics: Fentanyl; Humans; Male; Naloxone; Narcotic Antagonists; Pulmonary Edema; Respiratory Insufficiency; Sleep Apnea, Obstructive; Young Adult