Naloxone Induced Pulmonary edema in a patient operated for Laparoscopic Appendectomy- a case report.

Abstract

Naloxone induced pulmonary edema is a rare entity that can occur when Naloxone is used for treatment of opioid-induced respiratory depression in a perioperative period. The proposed mechanism includes an adrenergic crisis secondary to catecholamine surge which causes more volume shift to pulmonary vasculature, subsequently leading to pulmonary edema. Higher doses of naloxone will most commonly present with such clinical scenario. We present a case who underwent Laparoscopic Appendectomy under General Anesthesia. During the procedure, he received total Injection Fentanyl 150 mcg (0.22 mcg/kg) intraoperative and was shifted to Postoperative recovery unit after extubation. As patient was unable to maintain oxygen saturation and we suspected Opioid overdose, Injection Naloxone 0.4 mg was given intravenously as antidote. One hour later, this patient developed non- cardiogenic pulmonary edema diagnosed with chest X-ray, managed with Injection Lasix, Nebulization and Noninvasive ventilation.

Keywords: Naloxone, Pulmonary edema, opioid overdose, General anesthesia