Codeine Risk In Children, Especially Those With Sleep Apnea

Although the initial FDA warnings about potentially fatal overdose from codeine in children were released in 2012, I’m recently discovered that a few of my surgeon and nursing colleagues were still unaware of the potential risks. Therefore I thought it might be helpful to bring up the topic so people can remind their own colleagues of the risks of codeine in children.

Codeine must be used with extreme caution, if at all, in young children or pregnant women because of variants in the enzymes some patient’s use to metabolize the drug. Continue reading

Don’t Withhold Oxygen From That CO2 Retainer

There is often a great deal of confusion about how to manage the care of a patient with COPD because of unwarranted, and incorrect, concern that all patients with COPD are CO2 retainers. This fear of causing CO2 retention sometimes causes providers to withhold or withdraw oxygen inappropriately. Understanding some of the respiratory physiology behind CO2 retention will allow you to make more informed decisions. Let’s start at the beginning. Some of this material comes from my book Anyone Can Intubate, 5th Edition. Continue reading

Opioid Induced Respiratory Depression: A Balance in the Force

We will all see this scenario during our careers. I saw it myself again recently. The patient undergoes an uneventful anesthetic, awakens at the end, and is transferred to the recovery area. Upon arrival in recovery, the patient is no longer responsive and has marked respiratory depression. After a quick resuscitation with bag-valve-mask, some stimulation, and perhaps some intravenous naloxone, the patient wakes up.

That patient was just awake in the OR? What happened? During the postoperative period, there is constant change in the forces arousing your patient and those sedating your patient. The shift of balance in those forces can cause abrupt respiratory depression and apnea when you least expect it. Continue reading