APNOEA
- Jennifer de la Cruz
- Mar 5
- 2 min read
Updated: Mar 6
By: J. de la Cruz
Aim:
To explain the causes of apnoea in perioperative context.
Background:
Apnoea is the cessation of breathing. Anaesthetic apnoea is a serious complication that can occur in the post operative period. Understanding the underlying cause of apnoea enables efficient and effective response:
Causes and typical interventions:
Inadequate reversal of neuromuscular blockade. Check the train of four (TOF )for full reversal signs. The smallest muscles reverse last—look out for eye opening as well before removing airway device.
Hypercapnic narcosis - excessively elevated carbon dioxide levels in the blood can depress respiratory drive. Administration of oxygen through a mask and applying jaw thrust are good responses to wash out excess carbon dioxide until help arrives.
Opioid induced respiratory depression- can be reversed by naloxone.
Central nervous system depression- avoid early removal of airway device, understand adequate level of sedation.
Obstructive sleep apnoea patients are at higher risk of developing respiratory complications in the post operative period. Ensure adequate level of consciousness, apply oxygen mindfully, jaw thrust and position the patient in a semi upright position if appropriate to optimise lung expansion and breathing.
Apnoea example scenarios:
A patient with known obstructive sleep apnoea (OSA), undergoes laparoscopic procedure. Fentanyl and morphine was administered for pain management. In PACU, despite adequate reversal of neuromuscular blockade, the patient develops recurrent apnoeic episodes—central respiratory pauses lasting 20+ seconds with desaturation to 85%. Possible cause: Opioids suppress respiratory drive and exacerbate upper airway collapsibility
A patient had been given a neuromucular block during surgery under general anaesthesia . Sugammadex was used to reverse blockade, but train-of-four monitoring showed some fade. In recovery, obstructive apnoea was observed: upper airway collapse with snoring, desaturation to 87%, and poor inspiratory effort. Possible cause: Residual blockade was indicated by fade in TOF.
References:
Kiekkas, P., Stefanopoulos, N., Bakalis, N., & Aretha, D. (2023). Residual neuromuscular blockade and postoperative pulmonary complications: An update. Journal of Critical Care, 75, 154233, https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.12508
Overdyk, F. J., Dowling, O., Marino, J., Qiu, J., Chien, H. L., Erslon, M. G., & Gu, J. (2023). Postoperative opioid-induced respiratory depression or oversedation requiring naloxone treatment in a community hospital: A case series. Anaesthesia and Intensive Care, 52(1–2), 32–40.
DISCLAIMER:The information presented here is provided for general educational and informational purposes only. It does not constitute medical advice and is not a clinical protocol. Readers must always refer to their institutional policies and clinical guidelines and consult with qualified healthcare professionals for individual patient care. The author and this site disclaim any liability for adverse outcomes that may result from the use or application of the information provided.
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