Intravenous and inhalational agents: naloxone titration: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Intravenous and inhalational agents: naloxone titration

Sample item

An opioid-sedated patient in recovery, breathing six times a minute, is given a full 0.4 mg bolus of naloxone and suddenly becomes agitated, hypertensive and tachycardic with pulmonary oedema. How should naloxone have been given?

AIntramuscularly at 0.4 mg every 5 minutes regardless of responseBIn small titrated intravenous increments until breathing is adequateCOnly by infusion after a loading dose of 0.8 mgDAs one larger dose of 2 mg to ensure complete reversal

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. In small titrated intravenous increments until breathing is adequate

Sudden full reversal of opioid effect removes analgesia and releases a sympathetic surge, causing pain, hypertension, tachycardia and sometimes pulmonary oedema. Naloxone is therefore titrated in small intravenous doses, and its short action may require repeat doses.

Option by option

A. Intramuscularly at 0.4 mg every 5 minutes regardless of response
Fixed intramuscular doses regardless of response cannot be titrated and are slow.
B. In small titrated intravenous increments until breathing is adequate (correct)
Correct. Small doses reverse respiratory depression while preserving some analgesia.
C. Only by infusion after a loading dose of 0.8 mg
A large loading dose gives the same abrupt reversal.
D. As one larger dose of 2 mg to ensure complete reversal
A large dose increases the chance of an abrupt sympathetic surge.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is B, In small titrated intravenous increments until breathing is adequate. Sudden full reversal of opioid effect removes analgesia and releases a sympathetic surge, causing pain, hypertension, tachycardia and sometimes pulmonary oedema.

Why is "Intramuscularly at 0.4 mg every 5 minutes regardless of response" not the answer?

Fixed intramuscular doses regardless of response cannot be titrated and are slow.

Why is "Only by infusion after a loading dose of 0.8 mg" not the answer?

A large loading dose gives the same abrupt reversal.

Why is "As one larger dose of 2 mg to ensure complete reversal" not the answer?

A large dose increases the chance of an abrupt sympathetic surge.

What concept does this question test?

It tests Intravenous and inhalational agents: naloxone titration in Anaesthesia. Naloxone is therefore titrated in small intravenous doses, and its short action may require repeat doses.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Intravenous and inhalational agents: naloxone titration?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.