Percentage of patients requiring the use of naloxone for opioid reversal.

Opioid overdose can lead to respiratory depression, brain damage, and even death. Adverse effects related to opioid administration may require administration of an opioid antagonist such as naloxone, which needs to be titrated in order to partially maintain analgesic effects as rapid reversal of opioid can lead to hypertension, pulmonary edema, tachycardia, or myocardial ischemia. Judicious use of opioids for patients that have planned extubation at the end of the case can avoid use of reversal agents and their side effects.  In an anesthetized patient, respiratory depression due to opioid administration negatively impacts attempts to maintain spontaneous ventilation, thus contributing to delayed extubation. For patients not meeting extubation requirements due to opioids or benzodiazepines, waiting until the effects wear off is preferable to reversal administration.^1-4

Anesthesia Start to PACU End

Patients who recieved opioids intraoperatively or in the immediate postoperative period.

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

Appropriate dosing of opioid administration where naloxone administration for reversal was avoided.

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

Pending.

Provider(s) signed in between Anesthesia Start and PACU End.

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.
3. Alexander JC, Patel B, Joshi GP. Perioperative use of opioids: Current controversies and concerns. Best Practice & Research Clinical Anaesthesiology 2019; 33:341–51 https://doi.org/10.1016/j.bpa.2019.07.009.

Published Date: 09/2023