Insidious opioid-induced respiratory depression following abdominal steel pipe perforation injury: A case report.
Opioid-induced respiratory depression (OIRD) is a potentially fatal complication associated with postoperative opioid use, even in low-risk populations. The subtle onset and progression of OIRD can delay detection, potentially leading to cardiorespiratory collapse within minutes.
A 55-year-old opioid-naïve male who underwent emergency surgery for abdominal penetrating trauma and unstable pelvic fracture. Postoperatively, despite sufentanil-based patient-controlled intravenous analgesia (PCIA), the patient experienced persistent moderate-to-severe pain. After acute pain service adjustment of PCIA parameters, the patient developed sudden unconsciousness with respiratory depression (respiratory rate, 7 breaths/min), hypoxemia (SpO2, 90%), bilateral 2-mm pinpoint pupils with sluggish reflexes, and generalized rigidity, despite no additional PCIA activations.
The critical care team promptly recognized the signs of opioid-induced wooden-chest syndrome, a rare and severe form of OIRD and implemented targeted interventions.
Initial administration of naloxone failed to reverse symptoms. The patient required urgent endotracheal intubation, during which marked chest wall rigidity was observed.
These timely interventions enabled the successful rescue of the patient, who was transferred back to a general nursing unit on postoperative day 2.
This case of OIRD due to opioid-induced wooden-chest syndrome underscores the danger of omitting dose titration in opioid-naïve patients. We therefore advocate for vigilant monitoring, strict titration protocols, and enhanced staff training to manage such emergencies.
A 55-year-old opioid-naïve male who underwent emergency surgery for abdominal penetrating trauma and unstable pelvic fracture. Postoperatively, despite sufentanil-based patient-controlled intravenous analgesia (PCIA), the patient experienced persistent moderate-to-severe pain. After acute pain service adjustment of PCIA parameters, the patient developed sudden unconsciousness with respiratory depression (respiratory rate, 7 breaths/min), hypoxemia (SpO2, 90%), bilateral 2-mm pinpoint pupils with sluggish reflexes, and generalized rigidity, despite no additional PCIA activations.
The critical care team promptly recognized the signs of opioid-induced wooden-chest syndrome, a rare and severe form of OIRD and implemented targeted interventions.
Initial administration of naloxone failed to reverse symptoms. The patient required urgent endotracheal intubation, during which marked chest wall rigidity was observed.
These timely interventions enabled the successful rescue of the patient, who was transferred back to a general nursing unit on postoperative day 2.
This case of OIRD due to opioid-induced wooden-chest syndrome underscores the danger of omitting dose titration in opioid-naïve patients. We therefore advocate for vigilant monitoring, strict titration protocols, and enhanced staff training to manage such emergencies.