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.