Epidemiology: - If patient-controlled systemic opioids are used in patients with obstructive sleep apnea, continuous background infusions should be used with extreme caution or avoided entirely (1).
- Nonsteroidal antiinflammatory agents and other modalities (e.g., ice, transcutaneous electrical nerve stimulation) should be considered if appropriate to reduce opioid requirements.
- Clinicians are cautioned that the concurrent administration of sedative agents (e.g., benzodiazepines, barbiturates) increases the risk of respiratory depression and airway obstruction.
Treatment: - In cases of uncontrolled pain during iv PCA (2):
- 1) Double of PCA dose every 10 min.
- 2) Double PCA dose, but be careful with methadone and sedatives.
References: - Practice guidelines for the perioperative management of patients with obstructive sleep apnea. Anesthesiology. 2006;104:1081- 1093: full text | pdf.
- M. Curatolo. Session III: Patients with chronic pain undergoing surgery. SGAR-Kongress. 2014.
|
|
