Incidence and demographics of post-operative naloxone administration: A 13-year experience at a major tertiary teaching institution

Background: perioperative use of opioids is associated with the risk of opioid-induced respiratorydepression. naloxone is a competitive opioid antagonist typically administered to reverse opioidinducedrespiratory depression. postoperative administration of naloxone may be considered aproxy for significant postoperative opioid-induced respiratory depression and data regarding itsuse may be utilized as a quality measure. few large studies have been done to characterize thepopulation and define an incidence of naloxone recipients in the postoperative inpatient setting.objectives: we aimed to characterize the demographics of patients receiving postoperativenaloxone,as well as the incidence of administration in the first 72 post-operative hours at a largeurban academic medical center in the united states.study design: this is a retrospective cohort study.setting: major urban tertiary teaching institution.methods: the robust electronic record database of the department of anesthesiology atthe icahn school of medicine at mount sinai,as well as the institution’s data warehouse wereinstrumental in allowing almost 450,000 surgical cases performed between 2001 and 2014 tobe screened for naloxone administration within the first 72 postoperative hours. organ harvests,outside of or intubations,cancelled cases,and patients age less than or equal to 18 were excludedfrom the total case count.results: naloxone was administered 433 times in a total of 442,699 postoperative cases. thisyielded an incidence of 0.1%. additionally,the demographics of the group receiving naloxonewere described. the mean age was 60,mean body mass index (bmi) was 27,60% were women,and the mean american society of anesthesiologists (asa) status was 3. average time to naloxoneadministration was 21 hours (standard deviation 7) after surgery. thirteen percent of the cases wereemergent. breakdown of anesthetic technique revealed that 81% of the cases were performedunder general anesthesia,7% with monitored anesthesia care (mac),and 12% under neuraxialanesthesia. this study lays the groundwork for further elucidating risk factors for postoperativeadministration of naloxone.limitations: this is a retrospective study.conclusion: the overall incidence of postoperative naloxone administration over a 13 yearperiod in approximately 450,000 patients was 0.1%. demographics of this group were older,asa3 women,qualifying as overweight,but not obese,undergoing elective surgery with a generalanesthetic technique. average time to administration was 21 hours postoperatively. © 2015,american society of interventional pain physicians. all rights reserved.