OpenTelemetry is designed for busy production environments and is "battle-tested" by many large organizations.
There is a minor impact on performances, you can read more about the benchmarks here: opentelemetry.io/docs/reference/specification/per… .
In our tests, we saw an impact of less than 1% in the overall avg query duration.
For a super busy production DB, it probably makes sense to sample the queries, say 1 out of 20.