A Methodology to Explore Ventilatory Chemosensitivity and Opioid-Induced Respiratory Depression Risk

Tiffany W Dong, David B MacLeod, Antoinette Santoro, Zachary Augustine, Stratton Barth, Mary Cooter, Richard E Moon
Journal of Applied Physiology 2020 July 16

PURPOSE: Reported incidence of postoperative opioid-induced respiratory depression (OIRD) range from 0.5 to 41% and is not reliably predicted by traditional risk factors. This study tests a new methodology to investigate ventilatory chemosensitivity as a new potential risk factor and explore OIRD distribution across sleep and wakefulness.

METHODS: Preoperative patient ventilatory chemosensitivity was quantified by hypercapnic ventilatory responses with (HCVRREMI , effect site concentration 0.7 or 2.0 ng/ml) and without (HCVRBL ) remifentanil during hyperoxia and hypoxia. Postoperative opioid consumption was recorded during hospital stays. OIRD frequency was the primary outcome of the study, detected as incidences of respiratory rate < 60% of baseline, minute ventilation < 60% of predicted value, pulse oximetry SpO2 < 90% (breathing room air) or 92% (supplemental O2 ), transcutaneous PCO2 > 50 mmHg, and central and obstructive apnea/hypopnea. Sleep stages were recorded until the first postoperative morning to determine the OIRD sleep distribution as the secondary outcome.

RESULTS: The methodology was feasible in implementation and posed no obstacles to standard care. In the nine patients studied (2 females, mean age 65 ± 7.5 years), remifentanil depressed HCVR to a highly variable degree. High OIRD frequency was generally observed with lower HCVRREMI . OIRD predominantly occurred during light sleep.

CONCLUSION: This study supports ventilatory chemosensitivity as an important predictor of OIRD, lending a new perspective to classify risk for OIRD and detailing a methodology in which to pursue this investigation for future studies. ( number NCT04047550).

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