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Intraoperative methadone: Proceed with care.

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Perioperative methadone may cause respiratory depression (RD), especially with other CNS depressants or adjuvant medications. Further investigation is needed on methadone

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Area of Science:

  • Anesthesiology
  • Pharmacology

Background:

  • Conflicting evidence exists regarding respiratory depression (RD) risk with perioperative methadone.
  • Previous studies report varying incidence rates of RD, from minimal to 37%.

Purpose of the Study:

  • To investigate the occurrence of RD in opioid-naive patients receiving perioperative methadone.
  • To identify potential contributing factors to methadone-induced RD.

Main Methods:

  • Retrospective case review of opioid-naive patients who received perioperative methadone and naloxone.
  • Electronic medical record search to identify additional cases.

Main Results:

  • Five of 75 (6.6%) opioid-naive patients required naloxone post-operatively.
  • RD appeared to be associated with concurrent use of adjuvant medications and/or home CNS depressants.

Conclusions:

  • Perioperative methadone can be associated with RD, particularly when combined with other CNS depressants or perioperative adjuvant medications.
  • The risks and benefits of perioperative methadone, especially in patients requiring naloxone, warrant further study.