Best Practices for Safe Opioid Use in Patients With OSA

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  Individualize opioid doses given postoperatively and titrate to effect (Macintyre et al., 2011).
  
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  Do not use a basal (continuous) dose when using PCA (Bolden et al., 2009; Jarzyna et al., 2011; Khan and Ali, 2008; Macintyre et al., 2011; Moos and Cuddeford, 2006).
  
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  The use of nonopioid analgesics may decrease the amount of opioids needed (Adesanya et al., 2010; Chung et al., 2008; Jigajinni et al., 2009; Khan and Ali, 2008; Pasero and McCaffery, 2011; Rudra et al., 2008).
  
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  Sedation should be monitored using a valid and reliable sedation scale (Craft, 2010; Hutchison and Rodriguez, 2008; Jarzyna et al., 2011; Macintyre et al., 2011; Pasero, 2009). The POSS scale is an example of a valid and reliable sedation scale (Pasero, 2009).
  
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  Patients should be positioned either with the head up 30 degrees or on the side (Adesanya et al., 2010; Chung et al., 2008; Khan and Ali, 2008; Rudra et al., 2008).
  
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  Patients who use a CPAP at home should use a CPAP after surgery at any time they are drowsy to help maintain the airway while receiving opioids. CPAP may also be of use to treat respiratory depression (Adesanya et al., 2010; Bolden et al., 2009; Haeck et al., 2009; Horlocker et al., 2009; Jigajinni et al., 2009; Khan and Ali, 2008; Moos and Cuddeford, 2006; Pace, 2008; Rudra et al., 2008; Shafazand, 2009).
  
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  A continuous pulse oximeter should be used to monitor oxygenation (Bamgbadea et al., 2009; Bolden et al., 2007; Bolden et al., 2009; Chung et al., 2008; Gay, 2010; Haeck et al., 2009; Jigajinni et al., 2009; Macintyre et al., 2011; Maddox et al., 2008; Moos and Cuddeford, 2006; Shafazand, 2009).
  
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  Capnography is a more sensitive indicator of ventilation and can help prevent respiratory complications (Haeck et al., 2009; Jarzyna et al., 2011; Maddox et al., 2008; McCarter et al., 2010; Pace, 2008; Pasero, 2009)