title: Remifentanil apnea: Case report and review of the literature.
abstract: Remifentanil is an opioid analgesic frequently used in intensive care patients because of its rapid onset of action, potency, and ultra-short duration. If an excessive dose is given, it leads to rapid, short lasting, potentially life-threatening side effects such as apnea, bradycadia, hypotension, and rigidity, following rapid peak serum levels. We report a 36-year-old woman developing apnea with bradycardia and hypotension, following an infusion in the central venous catheter lumen that had been used for remifentanil till tracheal extubation. The patient was immediately ventilated with bag-valve-mask and improved within 8 minutes. She became fully awake, heart rate and blood pressure returned to normal, and oxygen saturation improved to 100%. Acute care physicians, intensivists, anesthesiologists, and critical care nurses should be aware of this clinical problem in order prevent it as much as possible and to initiate immediate resuscitative measures.
authors.affiliation: Department of Anesthesiology and Intensive Care, Hamad Medical Corporation-Hamad General Hospital, Doha, Qatar.
authors.forename: Nissar
authors.initials: N
authors.lastname: Shaikh
authors.forename: Yolande
authors.initials: Y
authors.lastname: Hanssens
authors.forename: André
authors.initials: A
authors.lastname: Louon
references.citation: Anesth Analg. 1996 Dec;83(6):1292-7
references.pmid: 8942602
references.citation: Anesthesiology. 1993 Nov;79(5):893-903
references.pmid: 7902033
references.citation: Br J Anaesth. 2001 Sep;87(3):415-20
references.pmid: 11517125
references.citation: Anesth Analg. 1996 Aug;83(2):279-85
references.pmid: 8694306
references.citation: Acta Anaesthesiol Scand. 2005 Jul;49(6):876-9
references.pmid: 15954975