Reader Has Low Tolerance for Zero Tolerance

Robert F. LaPorta, PhD, MD

To the Editor:

I read with amazement the article “Dangers of Postoperative Opioids” (Vol 21, #4). The article states, “We advocate the use of continuous monitoring of oxygenation (generally pulse oximetry) and of ventilation in non-ventilated patients receiving PCA, neuraxial opioids, or serial doses of parenteral opioids.” Basically the APSF is instituting a new standard of care. This would require billions of dollars of equipment that the article acknowledges as being “plagued by false positive . . . and false negative . . . alarms” and thousands of new personnel to monitor the equipment and monitors.

I am surprised that the article did not recommend the abandonment of PCA, neuraxial opioids, or serial doses of parenteral opioids until perfect monitors were developed. This would go along with the desire of the authors to have “zero tolerance” for any respiratory morbidity associated with the use of opioids.

The only people this article helps are malpractice lawyers who can now ask us, “Doctor, are you not aware that your own safety foundation recommends monitoring for EVERY patient receiving opioids?”

Robert F. LaPorta, PhD, MD
Glen Cove, NY