Currently, one third of the US adult population is considered obese. As such, obese patients are a rapidly growing population of patients being admitted to ICU. The problems in managing pain for these patients, primarily perioperative and hospital-associated respiratory depression, are becoming increasingly apparent. New approaches for pain management are intended to minimize the life-threatening side effects of traditional pain control drugs (opioids) and to increase the therapeutic options with nonopioid agents. This article (a) reviews the pathophysiology of obstructive sleep apnea and other related sleep apnea syndromes, (b) describes risk factors for perioperative and hospital-associated respiratory depression, (c) reviews other significant side effects of opioid analgesic agents, and finally (d) summarizes the emerging consensus for the use of multimodal analgesia for managing pain in obese patients with obstructive sleep apnea.
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