ry distress — the lagging can be elongated if supplemental oxygen is
being administered to the patient. While continuous monitoring with
pulse oximetry is encouraged, the sole use of the technology to moni-
tor for respiratory depression during conscious sedation is not suffi-
cient. "Pulse oximetry is only designed to detect oxygen saturation
and heart rate, not the ventilatory status of a patient," says Richard
Kenney, MSM, RRT, NPS, ACCS, RCP, the director of respiratory care
services at White Memorial Medical Center in Los Angeles, Calif. "By
the time oxygen saturation has dropped and the alarms are alarming,
you've gotten beyond that threshold of the patient having a quick
recovery from that."
• Nursing assessment. For patients receiving opioids, intermittent
"spot checks" to determine key physiologic metrics are not sufficient
in isolation. Respiration can rapidly decelerate under the influence of
opioids, sometimes in a matter of minutes. By the time a patient expe-
riencing opioid-induced respiratory depression is visited again, it can
be too late to intervene.
In addition to pulse oximetry, you should also monitor with capnogra-
phy for adequacy of ventilation. Studies have shown that monitoring of
end-tidal CO
2
(EtCO
2
) provides an earlier indication of respiratory dis-
tress than pulse oximetry or intermittent checks — in one study
(osmag.net/FSx7Sk), at an average of 3.7 minutes earlier than pulse
oximetry.
Patients react to medication differently — a fact that is an undefined
factor, for example, in the opioid naive until it is too late. The situa-
tion can be further complicated by existing conditions and treatments.
Patients receiving opioids should undergo a pre-screening process to
identify crucial risk factors, such as obesity and obstructive sleep
apnea (OSA), as well as any potential conflicting existing prescrip-
O C T O B E R 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 3 1
