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Opioid respiratory depression in obstetrics — FRCA Final MCQ

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ModerateObstetric AnaesthesiaOpioid respiratory depression in obstetricsFRCA Final

A 24-year-old woman undergoing manual removal of placenta under spinal anaesthesia becomes drowsy, bradypnoeic and hypoxic after receiving repeated intravenous fentanyl for visceral discomfort. Sensory level is T8, blood pressure is 118/70 mmHg, and pupils are small. What is the most likely cause of the complication?

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Correct answer: D — Systemic opioid-induced respiratory depression

Bradypnoea, drowsiness and miosis after repeated fentanyl with a modest sensory level point to systemic opioid-induced respiratory depression. High spinal would be associated with a high block, hypotension, arm weakness or difficulty speaking. LAST usually has neurological excitation or cardiovascular instability. Treatment includes airway support, oxygen, stopping further opioid and titrated naloxone if clinically needed.

Reference: OAA obstetric analgesia guidance; BNF opioid safety information