周術期におけるナロキソン塩酸塩およびオピオイドの適正使用推進に対する取り組みの評価

抄録

Although naloxone is used as an opioid antagonist, naloxone has a short half-life compared with opioids such as morphine and fentanyl. Therefore, there is a risk of developing a re-respiratory depression after administering an initial dose of naloxone. In our hospital operating room, after the first administration of naloxone, incident cases that resulted in the re-respiratory depression were reported. In order to standardize and minimize the use of naloxone during the perioperative period, our hospital developed a new protocol for the use of opioids and naloxone in the post-anesthesia care unit. With the new protocol, naloxone administration was strictly managed by a clinical pharmacist to avoid arbitrary usage and to better monitor the incidence of adverse events. To minimize the need for opioid antagonists during the perioperative period, we also re-educated all anesthesiologists at our hospital on the proper use of opioids. We then retrospectively examined opioid usage, naloxone usage, the incidence of respiratory depression, and the incidence of adverse events before and after implementing the new protocol. The results indicate a significant reduction in the percentage of cases in which naloxone was used after the new protocol was implemented (P = 0.002). Naloxone was only used in one case, after the new protocol was implemented. Compared with the previous management method, there was a reduction in the usage of morphine after the new protocol was implemented. Based on the results of this study, the new protocol appears to effectively minimize the usage of naloxone during the perioperative period.