Patient-Controlled Analgesia

To the Editor. —In a recent article about the use of patient-controlled analgesia (PCA), Dr White 1 failed to mention a serious potential complication of this technology: accidental massive overdosage. The State of Utah Office of the Medical Examiner has investigated a case in which a previously healthy middle-aged woman was receiving meperidine via a PCA after uncomplicated elective surgery. The patient was discovered approximately 20 minutes after beginning PCA therapy, apneic and pulseless, with 49.5 mL of the original 60 mL of meperidine solution (10 mg/mL) missing from the PCA device. The patient was resuscitated but remained comatose until her death five days later. Toxicological analysis of blood samples drawn at the time of resuscitation revealed a meperidine level of 4.2 μg/mL, well within the fatal range of 1 to 8 μg/mL. 2 Autopsy revealed cerebral anoxic changes and recent surgery, with no other pathological abnormalities. The PCA device