Anaes Cases · Opioids & analgesics
Postoperative opioid respiratory depression
Short case — opioid-induced respiratory depression on PCA. Naloxone titrated; reduce or stop PCA; monitoring; cause (background infusion? opioid tolerant? hepatic/renal?).
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ANZCAFRCAABAEDAIC
Prompt
On the ward, 4 hours postoperatively, the patient on morphine PCA has respiratory rate 8 and sedation score 3. Manage.
Presentation
On the surgical ward, 4 hours after open cholecystectomy, the patient on morphine PCA (1 mg bolus, 5 minute lockout) has respiratory rate 8, SpO2 90 per cent on room air, sedation score 3 (difficult to rouse). PCA shows 15 mg used in 4 hours (within limit). Manage.
References1ShowHide
- [3]Lewis T, et al. Acute fentanyl toxicity: from opioid-induced to hypoxia-mediated pathophysiology. J Neurophysiol, 2026.PMID 42333655