Abstract
Purpose
To review the postoperative intrathecal morphine (ITM) analgesia literature for their definitions of “respiratory depression” (RD).
Source
Medline (1966 — June Week 5 2001) and reference lists were searched for original studies involving bolus-dose ITM for postoperative analgesia, which used “respiratory depression” or similar terms.
Principal findings
The search identified 209 studies. These were included if ITM use was appropriate (bolus dose, postoperative analgesia) and the term “respiratory depression” was used, which left 96 studies remaining. Forty-four (46%) did not define “RD” despite using this term. A further 24 (25%) defined RD with respiratory rate (RR) alone. Only 28 (29%) defined RD with more than RR alone. There was no statistically significant association between the presence of a definition for RD with study design, study size or publication period. Also, no significant association existed between rigorousness of RD definitions and the above factors.
Conclusion
The term “respiratory depression” has no clear definition from a review of the literature on ITM use for postoperative analgesia. While defining RD with bradypnea is superior to having no definition, this is still inadequate. In future research, the consistent use of terms with specific meanings will facilitate understanding the true incidence of ITM’s respiratory effects. If “respiratory depression” is used, then an explicit definition of its meaning should be provided. Future research must also address what is clinically significant respiratory impairment from intrathecal opioids, and how to optimally monitor for this. Further delineating their risksvs benefits will allow for more optimal dosing.
Résumé
Objectif
Passer en revue les documents sur l’analgésie postopératoire, réalisée avec la morphine intrathécale (MIT), quant à leurs définitions de la “dépression respiratoire” (DR).
Source
La base Medline (1966 — Semaine 5, juin 2001) et les listes de lectures de référence ont été fouillées à la recherche d’études originales sur des bolus de MIT administrés comme analgésie postopératoire, et dans lesquelles on retrouve le terme “dépression respiratoire” ou des termes similaires.
Constatations principales
La recherche nous a fourni 209 études. Les études (96) comportant un usage approprié de la MIT (dose en bolus, analgésie postopératoire) et l’utilisation du terme “dépression respiratoire” ont été retenues. Malgré l’utilisation du terme “DR”, 44 études (46 %) ne la définissaient pas. D’autres études, 24 (25 %), n’utilisaient que le terme “fréquence respiratoire” (FR) pour définir la DR. Seulement 28 (29 %) études en donnaient une définition plus large. Il n’y avait pas d’association significative entre la présence d’une définition de la DR et le devis de l’étude, sa taille ou sa date de publication. Aussi, aucune association significative n’a été trouvée entre la rigueur des définitions de la DR et les facteurs susmentionnés.
Conclusion
Le terme “dépression respiratoire” n’a pas de définition claire dans les documents examinés sur l’usage de la MIT comme analgésie postopératoire. Il est préférable de définir la DR par la bradypnée que de ne pas la définir, mais cela demeure incomplet. À l’avenir, l’usage uniforme de termes et de leurs définitions spécifiques facilitera la compréhension de la véritable incidence des effets respiratoires de la MIT. Le terme “dépression respiratoire” doit être accompagné d’une définition explicite. Les recherches à venir doivent traiter des affections respiratoires cliniques significatives causées par les opioïdes intrathécaux et de la façon de les déceler le plus efficacement. En déterminant davantage leurs risques et leurs bienfaits, nous pourrons en établir une posologie optimale.
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Ko, S., Goldstein, D.H. & VanDenKerkhof, E.G. Definitions of “respiratory depression” with intrathecal morphine postoperative analgesia: a review of the literature. Can J Anaesth 50, 679–688 (2003). https://doi.org/10.1007/BF03018710
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DOI: https://doi.org/10.1007/BF03018710