FENTANYL-INDUCED PERSISTENT ENCEPHALOPATHY

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Fentanyl is a synthetic opioid routinely used for sedation and analgesia in the intensive care unit (ICU). Though typically safe when vigilantly ICU-level care, it can sometimes cause serious adverse effects such as acute encephalopathy that usually improve with supportive care. We present rare case of persistent caused by fentanyl. CASE PRESENTATION: An 85-year-old functionally independent woman history chronic obstructive pulmonary disease (COPD) on 2 L oxygen, hypertension, hypothyroidism presented shortness breath dry cough four days. She was intubated mechanically ventilated worsening respiratory distress hypercapnia. required deep maximum doses fentanyl infusion 200 mcg/hr propofol 60 mcg/kg/min, vasopressor support norepinephrine two days to maintain her blood pressure. Sputum cultures grew Haemophilus influenza. treated 7 intravenous levofloxacin tracheobronchitis COPD exacerbation. also received methylprednisolone breathing treatments. Her status gradually improved she weaned down minimal ventilator FiO2 PEEP five days, but stayed unresponsive. Seven off sedation, had partial return consciousness altered mentation, quadriplegia, absence reflexes bilaterally. showed response painful stimuli all limbs. CT MRI head C-spine no pathology. Cerebrospinal fluid analysis ruled out infectious (including viral, bacterial, fungal) etiologies. 12-hour EEG consistent metabolic encephalopathy. After multidisciplinary evaluation, attributed Patient eventually extubated after 16 One month later, mild improvement neurological orientation only person. able slightly squeeze examiner's fingers both hands, foot plantar dorsiflexion 4/5 bilaterally rest motor strength 0/5 extremities. discharged nursing home unchanged status. DISCUSSION: has rapid onset short duration action making choice ICU. Acute infrequently associated other opioids like oxycodone methadone [1,2]. uncommonly causes delayed hypoxic leukoencephalopathy which develops few weeks exposure [3]. from lead significant functional impairment. CONCLUSIONS: It important clinicians be aware Sedation should caution especially elderly patients. Intermittent pushes or shorter use may prevent this complication. REFERENCE #1: Morales Odia Y, Jinka M, Ziai WC. Severe following intoxication. Neurocrit Care. 2010;13(1):93-97. #2: Haghighi-Morad Naseri Z, Jamshidi N, Hassanian-Moghaddam H, Zamani Ahmad-Molaei L. Methadone-induced encephalopathy: series literature review. BMC Med Imaging. 2020;20(1):6. #3: Kim J, Hyung SW, Seo Lee Yu HJ, Sunwoo MK. Delayed post-hypoxic intoxication healthy woman. Dement Neurocognitive Disord. 2020;19(4):170-172. DISCLOSURES: No relevant relationships Qasim Jehangir, source=Web Response Yi Lee, Ali Najar, Jonathan Toot,