Library resource guides: ANZCA and FPM CPD Program resources: Opioid-induced ventilatory impairment

Guide index

Opioid-induced ventilatory impairment

Workshop activity (face-to face or online) which aims which aims to ensure anaesthetists and pain medicine specialists have recognised training to recognise and respond to opioid induced ventilatory impairment.

Participate in an opioid-induced ventilatory impairment-related activity - find recognised courses and workshops on the college website.

CPD Value: CPD participants may claim this under Emergency response Opioid-induced ventilatory impairment activity.

Recommended resources/readings

In addition to the ANZCA and FPM document PS41(G) Position statement on acute pain management 2023, national guidelines that include advice for the recognition and management of OIVI in the acute pain setting as well as risk reduction have been published.

NPS MedicineWise: Safe use of opioids in acute pain
These resources have been developed to support best practice in the safe use of opioids for acute pain in the post-operative period and emergency department.

Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard by Australian Commission on Safety and Quality in Health Care
ISBN: 9781922563804
Publication Date: April 2022
This complete version of the Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard describes what each quality statement means for patients and their families, clinicians, and health service organisations, and provides indicators for local monitoring. It includes information about using clinical care standards, and the background and evidence sources for this standard.

Macintyre PE, Loadsman JA, Scott DA. Opioids, ventilation and acute pain management. Anaesth Intensive Care. 2011 Jul;39(4):545-58. Abstract available.
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Abstract
Despite the increasing use of a variety of different analgesic strategies, opioids continue as the mainstay for management of moderate to severe acute pain. However concerns remain about their potential adverse effects on ventilation. The most commonly used term, respiratory depression, only describes part of that risk. Opioid-induced ventilatory impairment (OIVI) is a more complete term encompassing opioid-induced central respiratory depression (decreased respiratory drive), decreased level of consciousness (sedation) and upper airway obstruction, all of which, alone or in combination, may result in decreased alveolar ventilation and increased arterial carbon dioxide levels. Concerns about OIVI are warranted, as deaths related to opioid administration in the acute pain setting continue to be reported. Risks are often said to be higher in patients with obstructive sleep apnoea. However, the tendency to use the term 'obstructive sleep apnoea' to encompass the much broader spectrum of sleep- and obesity-related hypoventilation syndromes and the related misuse of terminology in papers relating to obstructive sleep apnoea and sleep-disordered breathing remain significant problems in discussions of opioid-related effects. Opioids given for management of acute pain must be titrated to effect for each patient. However strategies aiming for better pain scores alone, without highlighting the need for appropriate monitoring of OIVI, can and will lead to an increase in adverse events. Therefore, all patients must be monitored appropriately for OIVI (at the very least using sedation scores as a '6th vital sign') so that it can be detected at an early stage and appropriate interventions triggered.

ANZCA & FPM resources

CPD Activity Guide
This guide contains a list of all the activities associated with the ANZCA and FPM CPD Program, as well as links to associated individual activity guides and forms.
ANZCA and FPM CPD Program: Opioid induced ventilatory impairment ER session guideline
This guideline assists hospitals, private practice groups and other course providers develop and conduct Opioid induced ventilatory impairment (OIVI) Emergency Response (ER) sessions. It defines the learning objectives and other requirements for education providers to become recognised OIVI ER providers for the purposes of the ANZCA and FPM CPD program.
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For CPD participants, this guideline provides information on what recognised OIVI ER sessions involve and how to record this activity.
OIVI ER activity recognition of suitability application form
Course providers must apply for college recognition of your session as a suitable OIVI ER activity for the ANZCA and FPM CPD program. Providers are encouraged to develop sessions that also satisfy local needs, incorporating local staff, work environments and equipment.
PS41(G) Position statement on acute pain management 2023
This document is intended to apply to specialists of the college (ANZCA and FPM), trainees, and SIMGs managing acute pain. It may be used as a reference by acute pain services as well as all doctors prescribing analgesia for acute pain within hospital settings. It is intended to apply to the management of all forms of acute pain including non-surgical acute pain.
PS41(G)BP Position statement on acute pain management Background Paper 2023
The purpose of this revision was to update the guideline with evidence-based or, where there is limited evidence, expert consensus-based recommendations since it was last reviewed in 2013, and to broaden its scope to include more information about the more comprehensive concept of analgesic stewardship. It was prompted by the significant increase in clinical knowledge and greater recognition of the need to review safe management of the patient from preadmission to post discharge.