Opioid Use and Respiratory Compromise in the Interventional Suite: A Wake-up Call

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Department of Radiology; Department of Anesthesiology and Perioperative Medicine

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Chemical Actions and Uses | Radiology | Respiratory System | Respiratory Tract Diseases | Substance Abuse and Addiction | Therapeutics


The study by Urman et al (1) in this issue of Radiology addresses the effect of respiratory compromise among inpatients undergoing interventional radiology (IR) procedures performed with moderate sedation. The study was conducted by using a national all-payer database and included data from over 500 000 patients across 853 hospitals, collected during a 3-year period. The results demonstrated that, among a wide range of variables, long-term opioid therapy or active substance abuse were the strongest predictors of respiratory compromise, with an odds ratio (OR) of 2.7. This is almost twice that of the second strongest predictors: age 65 years or older (OR, 1.4) and sleep apnea (OR, 1.3). The reason for the significant association between long-term opioid therapy or active substance abuse and sleep apnea with periprocedural respiratory complications is likely twofold: A larger dose of sedative and analgesic drugs is required to achieve an adequate level of sedation in patients who are administered long-term opioid therapy or with substance use disorder, and this may result in unintended deep, rather than moderate, sedation. Furthermore, there is evidence for a higher periprocedural risk of respiratory compromise following procedural sedation in patients with sleep apnea. The latter is important because the prevalence of sleep apnea in the general population is on the rise (2). Patients with respiratory compromise incurred statistically higher costs, longer hospital stays, and higher rates of intensive care unit admission, need for mechanical ventilation, and death.

DOI of Published Version



Radiology. 2019 Sep;292(3):711-712. doi: 10.1148/radiol.2019191173. Epub 2019 Jul 2. Link to article on publisher's site

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