GasGasGas - Anaesthetic Science for Anaesthesia! Opioids Quiz: FRCA Primary Exam Viva Practice & Comparison Tables
Oct 13, 2025
This quiz dives deep into the fascinating world of opioids. Discover how opioids work at a cellular level and explore different receptor subtypes. Learn why diamorphine is both rapid and potent, and understand the significance of pKa for drug onset. The podcast also compares the onset of alfentanil and fentanyl while discussing the critical topic of context-sensitive half-times. Key insights into morphine metabolism and the risks of respiratory depression add to the rich educational content.
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Recognise And Treat Wooden Chest
- High-dose remifentanil or fentanyl can cause chest wall rigidity (wooden chest) via mu-mediated disinhibition.
- Management is neuromuscular blockade because paralysis abolishes the centrally mediated rigidity.
Manage Remifentanil‑Mediated Hyperalgesia
- Consider remifentanil-induced hyperalgesia when patients have severe postoperative pain after high remifentanil exposure.
- Treat with multimodal analgesia including paracetamol, NSAIDs, ketamine, clonidine or dexmedetomidine and review for complications.
Opioids Can Contribute To Serotonin Syndrome
- Some opioids (fentanyl, methadone) have serotonergic activity that can add to SSRIs and risk serotonin syndrome.
- Always include serotonin syndrome in the differential when sedated ICU patients on fentanyl plus SSRIs become hyperreflexic, febrile and tremulous.