PaperPostoperative day one: a high risk period for respiratory events
Section snippets
Methods
This was an institutional review board–approved retrospective case-control analysis of in-patients undergoing major surgical procedures at a large urban academic institution for fiscal years 2003 and 2004 (October 2002–September 2004). By using an administrative database (Eclipsys; Eclipsys Corporation, Boca-Raton, FL), nontrauma patients older than 18 years who underwent surgery requiring greater than 24 hours of postoperative stay were identified. We then sought the subgroup that was given
Results
From October 2002 to September 2004 there were 62 patients with a respiratory event that were identified (patients) and matched to 62 nonrespiratory event patients (controls). Table 1 includes information on age, sex, past medical history, type of surgery, and length of stay. The patients were older than the controls and there were more women in the study (77 of 124). Types of surgeries were similar between the patients and controls, with abdominal surgeries being the most prevalent. Heart,
Comments
In the postoperative period, analgesia is achieved most commonly by using narcotics. These narcotics usually are opioids, with morphine being the prototype of all opioids [7]. Because of great variability in clinical response to opioids and the steep sigmoid dose-response curve for opioid analgesics, dosing can be difficult [8]. Giving too high a dose of opioids can lead to respiratory depression. This occurs by a dose-dependent depression of ventilation when opioids bind to μ receptors in the
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