The Anesthesia Patient Safety Foundation posted the results of a discussion by its Board of Directors on ventilatory depression from neuraxial opioids and patient-controlled analgesia (PCA).  The discussion highlights the inherent dangers the techniques bring to postoperative care.  Each is highly effective for treating postoperative pain.

The conference attendees and participants are noted to have recognized the “underappreciated risk” that each carries.  The recommendation is for anesthesia providers to give consideration to continuous pulse oximetry for these patients during the postoperative period.

Dr. Stoelting cautions us to remember that pulse oximetry will monitor hypoxemia but not hypoventilation.  Be mindful of hypercapnia effects which can be somewhat masked by supplemental oxygen.

Recent discussion in the Anesthesia Patient Safety Foundation newsletter led to a discussion during our recent clinical meeting. As a group we reviewed the available literature on the subject. An excellent and leading resource for information is www.lipidrescue.org. The case reports in the literature are compelling for considering the use of 20% Intralipid after standard ACLS protocol has been unsuccessful. Consider  the information at the website above.