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Related Experiment Videos

Prolonged apnea after remifentanil.

Reed Y Nelson1, Brad Bretz, Talmage D Egan

  • 1Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA.

Journal of Clinical Anesthesia
|February 27, 2007
PubMed
Summary
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A patient experienced prolonged respiratory arrest after remifentanil anesthesia, which resolved with naloxone. This atypical reaction highlights potential risks of opioid infusions during general anesthesia.

Area of Science:

  • Anesthesiology
  • Pharmacology
  • Critical Care Medicine

Background:

  • Remifentanil is a potent, ultra-short-acting opioid commonly used in general anesthesia.
  • Opioid-induced respiratory depression is a known side effect, typically managed with dose titration and reversal agents.
  • Prolonged apnea is unusual, especially in young, healthy patients receiving standard anesthetic protocols.

Observation:

  • A young, healthy adult male developed prolonged apnea following a 4-hour infusion of remifentanil.
  • The apnea was reversible upon administration of naloxone, an opioid antagonist.
  • The patient's clinical presentation and pharmacokinetic data suggested an atypical response to the anesthetic agent.

Findings:

  • The case demonstrates a rare instance of prolonged respiratory arrest attributed to remifentanil infusion.

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  • Pharmacokinetic simulations supported the clinical observation of an atypical drug response.
  • Naloxone effectively reversed the opioid-induced respiratory depression, confirming the causative agent.

    • Implications:

    • This case underscores the importance of vigilant respiratory monitoring during and after remifentanil anesthesia.
    • It suggests that individual patient variability can lead to unexpected and prolonged responses to commonly used opioids.
    • Further investigation into the mechanisms of atypical opioid sensitivity may be warranted to optimize anesthetic safety.