Postoperative Opioid-Induced Respiratory Depression: Who Are at the Greatest Risk?

Abstract

Opioid-induced respiratory depression (OIRD) is a life-threatening complication in postoperative patients receiving opioids for pain management. Identifying patients at higher risk for OIRD is crucial to preventing adverse events associated with opioids. This narrative review aims to evaluate the risk factors associated with postoperative OIRD. The review synthesizes evidence from 22 studies, involving over 1.8 million postoperative patients, to understand the complexities of OIRD. It highlights significant variability in the incidence of OIRD, ranging from 0.1% to 46%. This variation is attributed to differences in monitoring techniques, definitions of respiratory depression, methods of opioid administration, and patient-specific factors. Certain characteristics, comorbidities, and surgical and anesthetic factors are associated with a higher incidence of OIRD. Key intrinsic patient
factors influencing OIRD include age, sex, BMI, opioid naïveté, and comorbidities such as obstructive sleep apnea, pulmonary, and cardiac diseases.