Medline ® Abstract for Reference 10
of 'Ethical considerations in effective pain management at the end of life'
Predictors of naloxone use for respiratory depression and oversedation in hospitalized adults.
Pawasauskas J, Stevens B, Youssef R, Kelley M
Am J Health Syst Pharm. 2014 May;71(9):746-50.
PURPOSE: Results of a study to determine the established risk factors most closely associated with the use of naloxone to reverse adverse effects of opioid analgesia in a hospital population are presented.
METHODS: In a retrospective case-control study at a community hospital, pharmacy dispensing records were used to identify 65 cases over a one-year period that involved the use of naloxone for the treatment of oversedation or respiratory depression and met the other inclusion criteria; another 65 patients who received opioid analgesia during the same period but did not require naloxone were identified as controls. The influence of demographics and clinical variables on the likelihood of naloxone use was analyzed by linear regression and chisquare testing.
RESULTS: Patients in the naloxone group had an average of 5 risk factors for opioid-induced oversedation or respiratory depression, compared with an average of 3.3 risk factors in the control group (p<0.001). Five factors were significantly associated with naloxone use: comorbid renal disease (odds ratio [OR], 6.034; 95% confidence interval [CI], 2.565-14.195), cardiac disease (OR, 5.829; 95% CI, 2.687-12.642), respiratory disease (OR, 3.600; 95% CI, 1.742-7.441), concurrent use of central nervous system-sedating medication (OR, 4.750; 95% CI, 1.949-11.578), and positive smoking status (OR, 4.7421; 95% CI, 2.114-9.256).
CONCLUSION: Hospitalized patients on general medical units who required naloxone to reverse opioid-induced oversedation or respiratory depression had significantly more risk factors than matched patients who did not require naloxone.
Jayne Pawasauskas, Pharm.D., BCPS, is Clinical Associate Professor, University of Rhode Island College of Pharmacy, Kingston, and Clinical Pharmacy Consultant, Pain Management, Kent Hospital, Warwick, RI. Benjamin Stevens, Pharm.D., is Staff Pharmacist, Liberty Drug&Surgical, Chatham, NJ. Rouba Youssef, M.A., is a doctoral candidate in behavioral science, Department of Psychology, University of Rhode Island. Michelle Kelley, Pharm.D., is Clinical Coordinator of Pharmacy Services, Kent Hospital.