This article reviews factors related to postoperative opioid-induced respiratory depression (RD). The authors reviewed closed acute pain related anesthesia malpractice claims from 1990 to 2009 from the Anesthesia Closed Claims Program. RD is a significant cause of death and brain damage, with 77% of the cases identified in this study resulting in these outcomes. Most cases occurred within 24 hours of surgery and almost all cases were deemed preventable with enhanced monitoring and response. Common risk factors were identified, including multiple prescribers, concurrent use of non-opioid sedating medications, and inadequate nursing assessment or response.

Most anesthesia malpractice claims for medication management problems involved patients with a history of risk behaviors commonly associated with medication misuse. Malpractice claims arising from medication management had a high proportion of deaths with both patient and physician contributions to the outcome.