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This Article Full Text Full Text (PDF) CME: Take the course for this article: Respiratory Depression During Patient-Controlled Analgesia Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Overdyk, F. J. Articles by Henriquez, C. Search for Related Content PubMed PubMed Citation Articles by Overdyk, F. J. Articles by Henriquez, C.

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PATIENT SAFETY

Continuous Oximetry/Capnometry Monitoring Reveals Frequent Desaturation and Bradypnea During Patient-Controlled Analgesia

Frank J. Overdyk, MSEE, MD, Diplomate ABA^*, Rickey Carter, PhD, Ray R. Maddox, PharmD, Jarred Callura, BS, Amy E. Herrin, MS, and Craig Henriquez, PhD

From the Departments of *Anesthesia and Perioperative Medicine, and Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston, South Carolina; Department of Clinical Pharmacy, Research, and Pulmonary Medicine, St. Joseph's/Candler Medical Center, Savannah, Georgia; and Department of Biomedical Engineering, Duke University, Durham, North Carolina.

Address correspondence to Frank J. Overdyk, MSEE, MD, Department of Anesthesia and Perioperative Medicine, 165 Ashley Ave., Suite 525, P.O. Box 250912, Charleston, SC 29425. Address e-mail to overdykf{at}musc.edu.

Abstract

BACKGROUND: The most serious complication of patient-controlled analgesia (PCA) is respiratory depression (RD). The incidence of RD in the literature is derived from intermittent sampling of pulse oximetry (Spo₂) and respiratory rate and defined as a deviation below an arbitrary threshold.

METHODS: We monitored postsurgical patients in a hospital ward receiving morphine or meperidine PCA with continuous oximetry and capnography. Nurses responding to audible monitor bedside alarms documented respiratory status and interventions.

RESULTS: A total of 178 patients were included in the analysis, 12% and 41% of whom had episodes of desaturation (Spo₂ <90%) and bradypnea (respiratory rate <10) lasting 3 min or more. One patient required "rescue" with positive pressure ventilation, and none required naloxone. Patients over 65 years of age and the morbidly obese were at greater risk for desaturation. Patients over 65 years of age were also more likely to have bradypnea, whereas the morbidly obese and patients receiving continuous infusions were less likely to have bradypnea.

CONCLUSIONS: Our incidence of RD by bradypnea is significantly higher than the 1%–2% incidence in the literature, using the same threshold criteria but more stringent duration criteria, while our incidence of RD based on desaturation is consistent with previous estimates. We conclude that continuous respiratory monitoring is optimal for the safe administration of PCA, because any RD event can progress to respiratory arrest if undetected. Better alarm algorithms must be implemented to reduce the frequent alarms triggered by threshold criteria for RD.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999