New ASA Guidelines Address Aggressive Pain Treatments, Related Respiratory Depression

Newswise — As a growing body of evidence suggests that aggressive treatment of pain, by either intravenous or neuraxial opioids may be associated with respiratory depression, the American Society of Anesthesiologists has released updated Practice Guidelines for the Prevention, Detection and Management of Respiratory Depression Associated with Neuraxial Opioid Administration. The updated guidelines can be found in the February 2009 journal Anesthesiology.

The updated Practice Guidelines which include new survey data and recommendations pertaining to monitoring for respiratory depression seek to improve patient safety and enhance the quality of anesthetics provided by anesthesiologists and other physicians administering neuraxial opioids by reducing the incidence and severity of respiratory depression related to treatment of pain.

"As more patients seek treatment for acute and chronic pain, it is important that physicians recognize and manage possible adverse effects of these pain treatments, including the serious occurrence of respiratory depression," said Terese T. Horlocker, M.D., chair of the ASA Task Force on Neuraxial Opioids.

Focused on the treatment of all patients receiving epidural or spinal administration of opioids in inpatient or ambulatory settings, the guidelines are outlined in four key areas with specific treatment recommendations:

-Identification of Patients at Increased Riske of Respiratory Depression, including recommendations for focused history and physical examination.

-Prevention of Respiratory Depression after Neuraxial Opioid Administration, including recommendations for noninvasive positive pressure ventilation, drug selection and dose selection.

-Detection of Respiratory Depression and Management, including recommendations for patient monitoring for adequacy of ventilation, oxygenation and level of consciousness.

-Management and Treatment of Respiratory Depression, including recommendations for supplemental oxygen, reversal agents and noninvasive positive pressure ventilation to improve respiratory rate and reduce adverse outcomes.

For copies of The Practice Guidelines for the Prevention, Detection and Management of Respiratory Depression Associated with Neuraxial Opioid Administration" can be found on the Web sites for the journal Anesthesiology, www.anesthesiology.org and the American Society of Anesthesiologists, www.asahq.org.

Anesthesiologists: Physicians providing the lifeline of modern medicine. Founded in 1905, the American Society of Anesthesiologists is an educational, research and scientific association with 43,000 members organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.

For more information visit the American Society of Anesthesiologists Web site at www.asahq.org.