A 29 year-old man was brought to the emergency room after a motor vehicle accident.

 He was in excruciating pain, requiring significant fentanyl (2.5 mg;Sublimaze) given as divided doses preoperatively.
Laparotomy was acquired to repair a ruptured liver. Blood transfusions were necessary, but at the close of the procedure his circulatory values were normal.

His anesthesia was with thiopental (Pentothal), roncuronium (Zemuron), and nitrous oxide/isoflurane (Forane)/oxygen with fentanyl (Sublimaze) 10ug given just before induction, in the same dose during abdominal closure to minimize pain upon awakening.

However, when surgery was completed, he remained apneic after the inhalational agents were discontinued

case author: Hugh S. Mathewson, M.D., Professor Emeritus, School of Allied Health, Department of Nurse Anesthesia, University of Kansas Medical Center
case editor: Michael Gordon, Ph.D.