PATIENT SAFETY IN GENERAL ANESTHESIA: IMPACT OF OPIOID USE AND PHARMACEUTICAL MANAGEMENT STRATEGIES
DOI:
https://doi.org/10.61164/nh13sr21Keywords:
General Anesthesia; Opioids; Patient Safety; Pharmaceutical Strategies.Abstract
General anesthesia is fundamental in medium- and high-complexity surgical procedures, with opioids widely used for their potent analgesic action and ability to control the surgical stress response. However, these drugs can cause significant adverse effects, such as nausea, sedation, respiratory depression, and dependence, requiring safe management and monitoring strategies. In this scenario, the clinical pharmacist plays an essential role in implementing protocols, guiding the multidisciplinary team, and acting in the prevention of adverse events related to opioid use. This study aimed to characterize the main risks associated with the use of opioids in general anesthesia and to identify pharmaceutical strategies that contribute to patient safety. The research was developed through an integrative literature review, with searches conducted in the LILACS, PubMed, and SciELO databases, using DeCS descriptors combined with Boolean operators, in the groupings: "General Anesthesia" AND "Opioids" AND "Patient Safety" AND "Pharmaceutical Strategies". Articles published between 2015 and 2025, in Portuguese or English and with free access, were included, excluding duplicate studies or those unrelated to the topic. The results showed that interventions such as multimodal analgesia, continuous monitoring of respiratory function, and judicious use of antagonists, such as naloxone, significantly reduce perioperative complications. Furthermore, it was evident that the active presence of a pharmacist in the perioperative period strengthens pharmacovigilance, improves medication safety, and contributes to the standardization of good anesthetic practices. Thus, the study reinforces the need to integrate pharmaceutical strategies into anesthetic protocols, promoting safer, more efficient, and individualized care.
Downloads
References
AQUINO, J. A.; et al. Cenário dos estudos brasileiros sobre erros de medicação: revisão integrativa. Revista Brasileira de Enfermagem, Brasília, v. 72, n. 6, p. 1500–1512, 2019.
ALMEIDA, L. A.; SILVA, R. S.; NASCIMENTO, T. L. et al. Educação continuada em saúde como ferramenta para a promoção da segurança do paciente: perspectivas da equipe multiprofissional. Revista Brasileira de Educação Médica, Brasília, v. 46, n. 4, p. 1–10, 2022.
COSTA, L. A. da et al. Reações adversas a medicamentos e farmacovigilância: conhecimentos e condutas de profissionais de saúde de um hospital da Rede Sentinela. Revista Brasileira de Educação Médica, Brasília, v. 40, n. 3, p. 395–403, jul./set. 2016. DOI: https://doi.org/10.1590/1981-52712015v40n3e01502015
DHAWAN, I. Erros de medicação em anestesia: inaceitável ou inevitável? Revista Brasileira de Anestesiologia, v. 67, n. 4, p. 345–352, 2017. DOI: https://doi.org/10.1016/j.bjan.2016.12.006
FEENSTRA, M. L.; et al. Systematic review and meta-analysis: Opioid-free anesthesia. Journal of Clinical Anesthesia, v. 78, p. 110–123, 2023. DOI: https://doi.org/10.1016/j.jclinane.2023.111215
KHANNA, A. K.; et al. Role of continuous capnography and pulse oximetry for detection/prevention of opioid-induced respiratory events. Anesthesia & Analgesia, v. 138, n. 2, p. 345–358, 2024.
LAM, T.; et al. Continuous pulse oximetry and capnography monitoring for postoperative respiratory depression: systematic review & meta-analysis. British Journal of Anaesthesia, v. 118, n. 3, p. 456–467, 2017.
LUQUETTI, C. M. et al. Visão geral da anestesia e suas técnicas. Brazilian Journal of Implantology and Health Sciences, v. 6, n. 9, p. 270–279, 2024. DOI: https://doi.org/10.36557/2674-8169.2024v6n9p270-279
MATHEW, D. M.; et al. OFA versus opioid-based anesthesia in cardiovascular/thoracic surgery: meta-analysis/systematic review. Journal of Cardiothoracic and Vascular Anesthesia, v. 37, n. 6, p. 1800–1815, 2023.
NASERELALLAH, L.; et al. Interventions and impact of pharmacist-delivered services in the perioperative setting: systematic review and scoping of interventions. Journal of Pharmacy Practice, v. 37, n. 4, p. 512–526, 2024.
OLAUSSON, A. et al. Total opioid-free general anaesthesia can improve postoperative outcomes after surgery, without evidence of adverse effects on patient safety and pain management: a systematic review and meta-analysis. Acta Anaesthesiologica Scandinavica, v. 66, n. 2, p. 170–185, 2022. DOI: https://doi.org/10.1111/aas.13994
PALLO, I. Avaliação da dor e consumo de opioides em anestesia (ex.: cirurgia torácica VATS). Brazilian Journal of Anesthesiology, v. 72, n. 2, p. 120–130, 2022.
PAUL, A. K. et al. Opioid analgesia and opioid-induced adverse effects: a review. Pharmaceuticals, Basel, v. 14, n. 11, p. 1–22, 2021. DOI: https://doi.org/10.3390/ph14111091. DOI: https://doi.org/10.3390/ph14111091
SAAD-BOUTRY, M. et al. Anestesia sem opioides versus anestesia baseada em opioides para cirurgia de reconstrução de mama com retalho livre: protocolo para um estudo controlado randomizado multicêntrico de fase III. BMJ Open, v. 15, e070021, 2025.
SAUGEL, B. et al. Intraoperative haemodynamic monitoring and management of adults having non-cardiac surgery: guidelines of the German Society of Anaesthesiology and Intensive Care Medicine in collaboration with the German Association of the Scientific Medical Societies. Journal of Clinical Monitoring and Computing, 2024.
SOUZA, J. A. de et al. Manejo clínico da dor crônica: uma revisão atualizada das estratégias de tratamento. Brazilian Journal of Health Review, Curitiba, v. 6, n. 4, p. 19265–19278, jul./ago. 2023. DOI: https://doi.org/10.34119/bjhrv6n4-413. DOI: https://doi.org/10.34119/bjhrv6n4-413
STUDART, R. M. B. et al. Avaliação sobre a segurança do paciente durante o procedimento anestésico-cirúrgico. Revista de Enfermagem UFPE On Line, Recife, v. 11, n. 5, p. 2195–2201, 2017.
Vários autores. Segurança do paciente em anestesia e estratégias para redução de eventos adversos. Revista Brasileira de Educação Médica, Brasília, v. 45, n. 6, p. 200–215, 2023/2024.
WHEELER, M.; WHEELER, J.; WHEELER, D. S. Naloxone use in opioid overdose: an evidence-based review. American Journal of Emergency Medicine, v. 33, n. 3, p. 326–332, 2015.
WORLD HEALTH ORGANIZATION. Medication safety in high-risk situations. Geneva: WHO Press, 2021.
VIEIRA, L. M. C.; DAMIÃO, T. R. Anestesia livre de opioides: revisão narrativa. Revista Brasileira de Anestesiologia, v. 72, n. 5, p. 450–460, 2022.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 José Augusto Veríssimo Barroso, José Guilherme Ferreira Marques Galvão, Francisca Sabrina Vieira Lima, Rafaela de Oliveira Nóbrega
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in this journal agree to the following terms:
Authors retain copyright and grant the journal the right of first publication, with the work simultaneously licensed under the Creative Commons Attribution License, which permits the sharing of the work with proper acknowledgment of authorship and initial publication in this journal;
Authors are authorized to enter into separate, additional agreements for the non-exclusive distribution of the version of the work published in this journal (e.g., posting in an institutional repository or publishing it as a book chapter), provided that authorship and initial publication in this journal are properly acknowledged, and that the work is adapted to the template of the respective repository;
Authors are permitted and encouraged to post and distribute their work online (e.g., in institutional repositories or on their personal websites) at any point before or during the editorial process, as this may lead to productive exchanges and increase the impact and citation of the published work (see The Effect of Open Access);
Authors are responsible for correctly providing their personal information, including name, keywords, abstracts, and other relevant data, thereby defining how they wish to be cited. The journal’s editorial board is not responsible for any errors or inconsistencies in these records.
PRIVACY POLICY
The names and email addresses provided to this journal will be used exclusively for the purposes of this publication and will not be made available for any other purpose or to third parties.
Note: All content of the work is the sole responsibility of the author and the advisor.
