Percentage of patients requiring the use of nalaxone or flumazenil for reversal.

Opioid and/or benzodiazepine administration can lead to respiratory depression, brain damage, and even death.   Judicious use of opioids for patients that have planned extubation at end of case can avoid use of reversal agents and their side effects.  For patients not meeting extubation requirements due to opioids or benzodiazepines, waiting until the effects wear off is preferable to reversal administration.

Anesthesia Start to Anesthesia End

All patients receiving opioids or benzodiazepines intraoperatively.

• ASA 5 & 6 including Organ Procurement (CPT: 01990)
• Cases where naloxone or flumazenil is administered before the first dose of opioid/benzodiazepine
• Patients not given opioids or benzodiazepines during the intraoperative period
• Patients that are still intubated at anesthesia end (as determined by no Extubation Time recorded for the case)
• ECT

Administration of naloxone or flumazenil was not required for the case.

Special Considerations: If naloxone was given as an infusion AND as a bolus, the case is flagged due to the bolus. If naloxone is only given as an infusion, then the case is still evaluated for flumazenil. Patients receiving naloxone as in infusion indicate naloxone is being infused for pruritus for neuraxial technique.

MED 01 is an outcome measure that identifies intraoperative medication overdose by monitoring the administration of opioids and/or benzodiazepines and the administration of reversal agents: flumanzenil and naloxone.

*This measure will include only valid MPOG cases as defined by the Is Valid Case phenotype.

Pending.

Primary Provider - Provider(s) present for longest duration of the case per staff role.

1. Lee LA, Caplan RA, Stephens LS, Posner  KL, Terman GW, Voepel-Lewis T, Domino KB. Postoperative opioid- induced respiratory depression: A closed claims analysis. Anesthesiology. 2015;122(3):659-665.
2. Ramachandran SK, Haider N, Saran KA, Mathis M, Kim J, Morris M, O’Reilly M. Life-threatening critical respiratory events: A retrospective study of postoperative patients found unresponsive during analgesic therapy. J Clin Anesth. 2011;23:207–13.