Risk Factors for Respiratory Depression in Patients Undergoing Retrobulbar Block for Vitreoretinal Surgery

Purpose: To investigate the possible risk factors and prognosis of initial no light perception (NLP) in pediatric open globe injuries (POGI). Procedures: This retrospective, comparative, interventional case-control study included 865 eyes of POGI patients presenting to a tertiary referral ophthalmic center from 1 January 2011 to 31 December 2015. Eyes were divided into two groups: NLP group included eyes with initial NLP, and light perception(LP) group included eyes with initial LP or vision better than LP. Results: The following risk factors were significantly related to initial NLP: severe intraocular hemorrhage (OR=3.287, p=0.015), retinal detachment (RD) (OR=2.527, p=0.007), choroidal damage (OR=2.680, p=0.016) and endophthalmitis (OR=4.221, p＜0.001). Choroidal damage is related to remaining NLP after vitreoretinal surgery (OR=12.384, p=0.003). At the last visit, more eyes in the NLP group suffered from silicone oil–sustained status (OR=0.266, p=0.020) or ocular atrophy (OR=0.640, p=0.004), and less eyes benefitted from final LP (OR=41.061, p＜0.001) and anatomic success (OR=4.515, p＜0.001). Conclusion: Severe intraocular hemorrhage, RD, choroidal damage and endophthalmitis occurred more often in POGI with initial NLP. Choroidal damage was the major factor related to an NLP prognosis. Traumatized eyes with initial NLP could be anatomically and functionally preserved by vitreoretinal surgery.

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Incidence of and Risk Factors for Neonatal Respiratory Depression and Encephalopathy in Rural Sarlahi, Nepal

PEDIATRICS ◽

10.1542/peds.2010-3590 ◽

2011 ◽

Vol 128 (4) ◽

pp. e915-e924 ◽

Cited By ~ 9

Author(s):

A. C. Lee ◽

L. C. Mullany ◽

J. M. Tielsch ◽

J. Katz ◽

S. K. Khatry ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Depression

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Craniotomy

Acute Pain Medicine ◽

10.1093/med/9780190856649.003.0016 ◽

2019 ◽

pp. 221-245

Author(s):

Roxana Grasu ◽

Sally Raty

Keyword(s):

Risk Factors ◽

Pain Management ◽

Side Effects ◽

Respiratory Depression ◽

Pain Control ◽

Sensory Nerves ◽

Current Evidence ◽

Multimodal Approach ◽

Perivascular Nerves ◽

Persistent Headache

This chapter discusses postcraniotomy headache (PCH), a common yet frequently underdiagnosed and undertreated occurrence, with up to 30% of patients experiencing persistent headache after surgery. The chapter identifies risk factors for the development of acute and persistent PCH and describes mechanisms for its development, such as injury to the sensory nerves supplying the scalp and underlying tissues or to the perivascular nerves that supply sensation to the dura mater. Pain management following craniotomy is a balancing act of achieving adequate analgesia while avoiding oversedation, respiratory depression, hypercapnia, nausea, vomiting, and hypertension. Current evidence suggests that a balanced, multimodal approach to the treatment of acute PCH is often required to optimize pain control, minimize undesired side effects, and prevent the development of persistent PCH.

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Remifentanil and Propofol Sedation for Retrobulbar Nerve Block

Anaesthesia and Intensive Care ◽

10.1177/0310057x0203000405 ◽

2002 ◽

Vol 30 (4) ◽

pp. 433-437 ◽

Cited By ~ 17

Author(s):

V. Rewari ◽

R. Madan ◽

H. L. Kaul ◽

L. Kumar

Keyword(s):

Adverse Effects ◽

Respiratory Depression ◽

Study Groups ◽

Group Iv ◽

Control Group ◽

Group Iii ◽

Group I ◽

Retrobulbar Block ◽

Significant Movement ◽

Group Ii

We studied remifentanil and propofol for analgesia and sedation during the placement of an ophthalmic block. Eighty ASA I or II patients undergoing elective cataract surgery under a retrobulbar block in a rural camp setting were included in the study. Patients were randomly divided into four groups and received different drug combinations as follows: Group I—remifentanil 1 μg/kg, Group II—remifentanil 0.5 μg/kg and propofol 0.5 mg/kg, Group III— remifentanil 1 μg/kg with propofol 0.5 mg/kg and Group IV—saline 0.1 ml/kg. Patients were observed for degree of movement, sedation, pain, recall and respiratory depression. No patient in the study groups reported pain or displayed movement whereas most of the patients in the control group had significant pain during the placement of the block. Also, seven (35%) patients in the control group showed significant movement which may have led to failure of block in two patients and retrobulbar haemorrhage in one patient. Incidence of significant respiratory depression was maximum in Group III patients (60%), followed by Group I (20%) and least in Group II (5%). All patients in the study groups remained cooperative and obeyed commands except four patients in group III (OAA/S-4). Postoperatively, other than the control group, recall was maximum in Group I (55%) and least in Group II (5%). Hence, a combination of remifentanil 0.5 μg/kg with propofol 0.5 mg/kg as a bolus was considered to provide excellent relief of pain and anxiety with least adverse effects for the placement of ophthalmic blocks.

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Postoperative Opioid-induced Respiratory Depression

Anesthesiology ◽

10.1097/aln.0000000000000564 ◽

2015 ◽

Vol 122 (3) ◽

pp. 659-665 ◽

Cited By ~ 204

Author(s):

Lorri A. Lee ◽

Robert A. Caplan ◽

Linda S. Stephens ◽

Karen L. Posner ◽

Gregory W. Terman ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Depression ◽

Brain Damage ◽

Perioperative Period ◽

Early Response ◽

Concurrent Administration ◽

Malpractice Claims ◽

Closed Claims ◽

Recurrent Patterns ◽

Level Monitoring

Abstract Background: Postoperative opioid-induced respiratory depression (RD) is a significant cause of death and brain damage in the perioperative period. The authors examined anesthesia closed malpractice claims associated with RD to determine whether patterns of injuries could guide preventative strategies. Methods: From the Anesthesia Closed Claims Project database of 9,799 claims, three authors reviewed 357 acute pain claims that occurred between 1990 and 2009 for the likelihood of RD using literature-based criteria. Previously cited patient risk factors for RD, clinical management, nursing assessments, and timing of events were abstracted from claim narratives to identify recurrent patterns. Results: RD was judged as possible, probable, or definite in 92 claims (κ = 0.690) of which 77% resulted in severe brain damage or death. The vast majority of RD events (88%) occurred within 24 h of surgery, and 97% were judged as preventable with better monitoring and response. Contributing and potentially actionable factors included multiple prescribers (33%), concurrent administration of nonopioid sedating medications (34%), and inadequate nursing assessments or response (31%). The time between the last nursing check and the discovery of a patient with RD was within 2 h in 42% and within 15 min in 16% of claims. Somnolence was noted in 62% of patients before the event. Conclusions: This claims review supports a growing consensus that opioid-related adverse events are multifactorial and potentially preventable with improvements in assessment of sedation level, monitoring of oxygenation and ventilation, and early response and intervention, particularly within the first 24 h postoperatively.

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Glaucoma drainage device surgery after vitreoretinal surgery: incidence and risk factors

Acta Ophthalmologica ◽

10.1111/aos.12910 ◽

2015 ◽

Vol 94 (2) ◽

pp. 135-139 ◽

Cited By ~ 6

Author(s):

Margriet M. de Vries ◽

Rogier P. H. M. Müskens ◽

Victor W. Renardel de Lavalette ◽

Johanna M. M. Hooymans ◽

Nomdo M. Jansonius

Keyword(s):

Risk Factors ◽

Vitreoretinal Surgery ◽

Glaucoma Drainage Device ◽

Drainage Device ◽

Surgery Incidence

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Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses

BMJ Open ◽

10.1136/bmjopen-2018-024086 ◽

2018 ◽

Vol 8 (12) ◽

pp. e024086 ◽

Cited By ~ 22

Author(s):

Kapil Gupta ◽

Mahesh Nagappa ◽

Arun Prasad ◽

Lusine Abrahamyan ◽

Jean Wong ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Respiratory Depression ◽

Meta Analysis ◽

Sleep Apnoea ◽

Factors Associated ◽

Obstructive Sleep ◽

Increased Risk ◽

Daily Dose ◽

Morphine Equivalent

ObjectiveThis systematic review and meta-analysis aim to evaluate the risk factors associated with postoperative opioid-induced respiratory depression (OIRD).DesignSystematic review and meta-analysis.Data sourcesPubMed-MEDLINE, MEDLINE in-process, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed and Clinicaltrials.gov (January 1946 to November 2017).Eligibility criteriaThe inclusion criteria were: (1) adult patients 18 years or older who were administered opioids after surgery and developed postoperative OIRD (OIRD group); (2) all studies which reported both OIRD events and associated risk factors; (3) all studies with reported data for each risk factor on patients with no OIRD (control group) and (4) published articles in English language.Data analysisWe used a random effects inverse variance analysis to evaluate the existing evidence of risk factors associated with OIRD. Newcastle-Ottawa scale scoring system was used to assess quality of study.ResultsTwelve observational studies were included from 8690 citations. The incidence of postoperative OIRD was 5.0 cases per 1000 anaesthetics administered (95% CI: 4.8 to 5.1; total patients: 841 424; OIRD: 4194). Eighty-five per cent of OIRD occurred within the first 24 hours postoperatively. Increased risk for OIRD was associated with pre-existing cardiac disease (OIRD vs control: 42.8% vs 29.6%; OR: 1.7; 95% CI: 1.2 to 2.5; I2: 0%; p<0.002), pulmonary disease (OIRD vs control: 17.8% vs 10.3%; OR: 2.2; 95% CI: 1.3 to 3.6; I2: 0%; p<0.001) and obstructive sleep apnoea (OIRD vs control: 17.9% vs 16.5%; OR: 1.4; 95% CI: 1.2 to 1.7; I2: 31%; p=0.0003). The morphine equivalent daily dose of the postoperative opioids was higher in the OIRD group than in the control; (24.7±14 mg vs 18.9±13.0 mg; mean difference: 2.8; 95% CI: 0.4 to 5.3; I2: 98%; p=0.02). There was no significant association between OIRD and age, gender, body mass index or American Society of Anesthesiologists physical status.ConclusionPatients with cardiac, respiratory disease and/or obstructive sleep apnoea were at increased risk for OIRD. Patients with postoperative OIRD received higher doses of morphine equivalent daily dose.

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