Clinical and radiologic features of pediatric opioid use‐associated neurotoxicity with cerebellar edema (POUNCE) syndrome

A 20-month-old boy weighing 15 kg underwent a successful surgery for hypospadias under general anesthesia. Before discharge, he was given a 2 mg dose of oral morphine. His parents reportedly administered a 3 mg dose of oral morphine at home 2 hours later. Three hours later, he appeared drowsy and was put to bed. The next morning, approximately 14 hours later, he was not arousable and the ambulance was called. His oxygen saturation was at 94%, blood pressure at 90/60, and had decreased level of consciousness with poor respiratory effort. His blood venous gas showed pH = 6.91, PCO2 = 115 mm Hg, PO2 = 21 mm Hg, and bicarbonate of 22 mmol/L. He had pinpoint pupils and abnormal dystonic posturing. He was given naloxone 0.15 mg twice, 1 hour apart, with no effect, and he was then intubated.

一名体重15kg的20月龄男童，在全身麻醉下成功接受尿道下裂（hypospadias）修复术。出院前，医护人员为其予口服吗啡2mg。据患儿家属陈述，家长于2小时后在家中为患儿给予了3mg口服吗啡。给药3小时后，患儿出现嗜睡症状并被安置卧床。次日清晨，即首次给药后约14小时，患儿无法被唤醒，家属遂呼叫急救救护车。接诊时患儿血氧饱和度为94%，血压90/60mmHg，意识水平下降且呼吸费力。静脉血气分析结果显示：pH值6.91，二氧化碳分压（PCO2）115mmHg，氧分压（PO2）21mmHg，碳酸氢盐浓度22mmol/L。患儿瞳孔呈针尖样缩小，伴异常肌张力障碍姿势。医护人员先后给予纳洛酮（naloxone）0.15mg，两次给药间隔1小时，但未见明显疗效，随后对患儿实施气管插管术。