Medicine (Baltimore). 2025 Oct 24;104(43):e45435. doi: 10.1097/MD.0000000000045435.
ABSTRACT
RATIONALE: 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.
PATIENT CONCERNS: 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.
DIAGNOSES: 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.
INTERVENTIONS: Initial administration of naloxone failed to reverse symptoms. The patient required urgent endotracheal intubation, during which marked chest wall rigidity was observed.
OUTCOMES: These timely interventions enabled the successful rescue of the patient, who was transferred back to a general nursing unit on postoperative day 2.
LESSONS: 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.
PMID:41137312 | DOI:10.1097/MD.0000000000045435
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