Risk Factors for Opioid-Induced Excessive Respiratory Depression

Carla R. Jungquist, RN, PhD; Suzanne Karan, MD; Michael L. Perlis, PhD


Pain Manag Nurs. 2011;12(3):180-187. 

In This Article

Abstract and Introduction


Opioid use has increased significantly over the past ten years and so has the incidence of reportable adverse events, such as respiratory depression and/or arrest. It is important for nurses to understand and know how to assess patients for risk factors for respiratory depression secondary to opioid therapy. This paper presents the pharmacodynamics of opioids, the risk factors for excessive respiratory depression, recommendations for identifying patients at high risk, and interventions to prevent adverse effects. After reading this paper, nurses will have the knowledge to provide safe administration of opioid medications for the management of acute pain.


According to the Adverse Event Reporting System (AERS) used by the Food and Drug Administration (FDA) to track adverse effects as reported by health care professionals, oxycodone and fentanyl were the two most frequently reported drugs associated with death and serious nonfatal outcomes from 1998 to 2005 (Moore, Cohen, & Furberg, 2007). In the hospital setting, despite nurses' vigilance, adverse events associated with the opioid class of medications continue to occur (Eckstrand et al., 2009). The most common etiology of the events is excessive sedation resulting in respiratory depression that is life threatening. The present article reviews the risk factors for postoperative pulmonary complications, the mechanism of respiratory depression from opioids, and the known risk factors for adverse events related to the use of opioid medications in the inpatient setting.


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