PeriAnesthesia nurses play a critical role in preventing opioid-related adverse events, such as excessive sedation and life-threatening respiratory depression (Pasero, 2013). Clinically significant opioid-induced respiratory depression can be prevented by careful opioid titration, close monitoring by the nurse of sedation and respiratory status, and opioid dose reduction if increasing sedation is detected (Pasero, 2009b). Opioid-induced sedation and respiratory depression are dose-related, suggesting that opioid orders and hospital protocols should include the expectation that nurses will stop titration or will promptly decrease the opioid dose whenever excessive sedation is detected, regardless of the level of pain relief. Patient safety is the primary consideration! Routine administration of nonsedating analgesics as part of a multimodal approach initiated preoperatively or as soon as the patient is started on opioid therapy is essential to help prevent excessive sedation from occurring later in the course of care (Pasero, Quinn, Portenoy, McCaffery, & Rizos, 2011; Pasero, 2013). In all patients with elevated risk, starting opioid doses should be decreased 25-50%. Continuous mechanical monitoring (e.g., pulse oximetry or capnography [ETCO2]) may also be indicated in some patients with high risk factors (Box 5-2).