[Apnea in the postanesthetic recovery room: case report]

Respiratory depression is a postoperative complication which may occur when opioids are employed in anesthesia. This report aimed at discussing a case of apnea in a conscious patient admitted to the post anesthetic recovery room, after thyroidectomy under general anesthesia with propofol, fentanyl and isoflurane.

Female patient, 50 years old, 60 kg, physical status ASA I, submitted to thyroidectomy under general anesthesia induced with propofol (140 mg), fentanyl (350 microg) and atracurium (30 mg), and maintained with isoflurane, two subsequent atracurium boluses (10 mg each) and mechanically controlled ventilation. At surgery completion and after neuromuscular block recovery, patient was extubated, responded to breathing commands and cooperated during transfer to the stretcher, being taken to the PACU, where she arrived fully conscious. Minutes after, she was apneic, cyanotic and unresponsive. Manual ventilation was installed with 100% oxygen, followed by intravenous naloxone (0,2 mg) and patient recovered spontaneous breathing and consciousness.

Respiratory care in the postoperative period, during transportation, PACU admission and stay should be continuous in patients receiving opioids, even when they seem fully conscious in leaving the operating room.