Anesthesiology Institute, Outcomes Research, Fairview Hospital, Cleveland Clinic, Cleveland, OH, USA; Outcomes Research Consortium, Cleveland, OH, USA.
Outcomes Research Consortium, Cleveland, OH, USA; Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
Br J Anaesth. 2019 Sep;123(3):378-391. doi: 10.1016/j.bja.2019.05.044. Epub 2019 Jul 19.
Respiratory depression is common in patients recovering from surgery and anaesthesia. Failure to recognise and lack of timely institution of intervention can lead to catastrophic cardiorespiratory arrest, anoxic brain injury, and mortality. Opioid-induced respiratory depression (OIRD) is a common and often under-diagnosed cause of postoperative respiratory depression. Other causes include residual anaesthesia, residual muscle paralysis, concurrent use of other sedatives, splinting from inadequate pain control, and obstructive sleep apnoea. Currently used methods to identify and monitor respiratory safety events in the post-surgical setting have serious limitations leading to lack of universal adoption. New tools and technologies currently under development are expected to improve the prediction of respiratory depression especially in patients requiring opioids to alleviate acute postoperative pain. In this narrative review, we discuss the various causes of postoperative respiratory depression, and highlight the advances in monitoring and early recognition of patients who develop this condition with an emphasis on OIRD.
呼吸抑制在术后和麻醉恢复的患者中很常见。如果未能识别和及时进行干预，可能导致灾难性的心肺骤停、缺氧性脑损伤和死亡。阿片类药物引起的呼吸抑制（OIRD）是术后呼吸抑制的常见且常常被低估的原因。其他原因包括残留麻醉、残留肌肉麻痹、同时使用其他镇静剂、因疼痛控制不佳而导致的夹板固定、阻塞性睡眠呼吸暂停。目前用于识别和监测术后呼吸安全事件的方法存在严重的局限性，导致其无法被普遍采用。目前正在开发的新工具和技术有望改善呼吸抑制的预测，尤其是在需要阿片类药物来缓解急性术后疼痛的患者中。在本叙述性综述中，我们讨论了术后呼吸抑制的各种原因，并强调了监测和早期识别发生这种情况的患者的进展，重点是 OIRD。
