Beware of basal opioid infusions with patient-controlled analgesia

摘要

Problem: A 63-year-old opioid-naive patient, weighing 109 kg, was admitted to a hospital with fractures sustained in a fall. She was given two doses of morphine 4 mg and one dose of HYDROmorphone 1 mg in the emergency department.Upon arrival at the impatient unit, she was started on HYDROmorphone patient-controlled analgesia (PCA), which included a basal infusion of 0.5 mg/hour, a demand dose of 0.2 mg with a lockout interval of 10 minutes, and a 4-hour limit of 6 mg. Continuous pulse oximetry was not in use. Five hours later, the patient was found to be unresponsive. Her respirations were six per minute, and her nail beds were beginning to turn blue. Oxygen saturation was checked with pulse oximetry and found to be 44%.