Ultra-rapid opioid detoxification increases spontaneous ventilation.
OBJECTIVE
To evaluate the effect of ultra-rapid opioid detoxification on spontaneous respiration.


METHODS
Prospective study.


METHODS
University of Illinois, Chicago, Hospital.


METHODS
20 ASA physical status I and II patients undergoing ultra-rapid opioid detoxification, and 5 ASA physical status I and II control patients undergoing surgical procedures.


METHODS
Ultra-rapid opioid detoxification patients were anesthetized with propofol, intubated, and spontaneously ventilating. Opioid detoxification was achieved by giving repeated increasing intragastric doses of naltrexone. Control patients were anesthetized with propofol and 70% nitrous oxide and were time-based controls for opioid detoxification.


RESULTS
Respiratory rate and minute ventilation were measured and increased 80% to 100% during opioid detoxification (p < 0.05). Respiratory rate and minute ventilation did not change in controls. Oxygen consumption and carbon dioxide (CO2) production were measured in separate studies and increased during ultra-rapid opioid detoxification with increases in spontaneous ventilation, but not when the patients were paralyzed.


CONCLUSIONS
Spontaneous ventilation increases during opioid detoxification without a change in end-tidal CO2. An increase in metabolism is produced in opioid withdrawal that is mediated by elevated muscle activity.
Department of Anesthesiology, University of Illinois at Chicago 60612, USA.
W E
WE
Hoffman
R
R
Berkowitz
T
T
McDonald
F
F
Hass
D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D002245:Carbon Dioxide / Q000378:metabolism; D005069:Evaluation Studies as Topic; D006801:Humans; D007441:Intubation, Gastrointestinal; D007442:Intubation, Intratracheal; D009271:Naltrexone / Q000008:administration & dosage / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D019148:Neuromuscular Blockade; D009609:Nitrous Oxide / Q000008:administration & dosage; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000503:physiopathology; D010101:Oxygen Consumption / Q000187:drug effects; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D012119:Respiration / Q000187:drug effects* / Q000502:physiology; D013990:Tidal Volume; D013997:Time Factors
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D009292:Narcotic Antagonists; D002245:Carbon Dioxide; D009271:Naltrexone; D009609:Nitrous Oxide; D015742:Propofol