A substantial number of preventable deaths and adverse events are related to the use of opioids, the most severe being opioid-induced ventilatory impairment (OIVI). This is one of the Anesthesia Patient Safety Foundation’s top, ongoing initiatives to ensure that “no patient shall be harmed by opioid-induced respiratory depression in the postoperative period.” We know that opioid-related adverse drug events (ORADEs) are associated with increased morbidity and mortality rates. Several coexisting conditions, such as obstructive sleep apnea (OSA), increase a patient’s risk for OIVI. In fact, expert consultants for the ASA Practice Guidelines for the Management of Obstructive Sleep Apnea agree that preprocedure identification of a patient’s OSA status improves perioperative outcomes. Ample evidence exists demonstrating that a patient’s perioperative risk depends on both the severity of the OSA, the invasiveness of the surgical procedure and the need...

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