Intraoperative methadone: Proceed with care

Abdul Kader Tabbara, MD; Sindhu Krishnan, MD; Eduard Vaynberg, MD; Nicole Z. Spence, MD; Donald H. Lambert, MD, PhD

doi:10.5055/jom.2022.0730

Authors

Abdul Kader Tabbara, MD
Sindhu Krishnan, MD
Eduard Vaynberg, MD
Nicole Z. Spence, MD https://orcid.org/0000-0002-7915-3987
Donald H. Lambert, MD, PhD

DOI:

https://doi.org/10.5055/jom.2022.0730

Keywords:

perioperative pain, perioperative methadone, respiratory depression, analgesia, polypharmacy

Abstract

A recent review suggests minimal respiratory depression (RD) after perioperative methadone, while another identified RD in up to 37 percent of patients. A meta-analysis is equivocal. At our institution, five of 75 opioid naive patients (6.6 percent) given perioperative methadone received naloxone. We report three of these cases in detail. Two others were discovered during an electronic medical record search for opioid naïve patients who received methadone plus naloxone during their anesthesia care. Our five patients indicate that RD owing to methadone can occur with excessive perioperative adjuvant medications and/or in patients who are taking home central nervous system depressants. We define perioperative adjuvant medications as medications given by the anesthesiologist prior to induction and intraoperatively. The risks and benefits of perioperative methadone administration, specifically in patients who received post-operative naloxone, deserve further investigation.

Author Biographies

Abdul Kader Tabbara, MD

Resident, Boston Medical Center, Boston, Massachusetts

Sindhu Krishnan, MD

Resident, Boston Medical Center, Boston, Massachusetts

Eduard Vaynberg, MD

Assistant Professor, Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts

Nicole Z. Spence, MD

Assistant Professor, Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts

Donald H. Lambert, MD, PhD

Professor, Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts

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