Incidence, Reversal, and Prevention of Opioid-induced Respiratory Depression.
Opioid treatment of pain is generally safe with 0.5% or less events from respiratory depression. However, fatalities are regularly reported. The only treatment currently available to reverse opioid respiratory depression is by naloxone infusion. The efficacy of naloxone depends on its own pharmacological characteristics and on those (including receptor kinetics) of the opioid that needs reversal. Short elimination of naloxone and biophase equilibration half-lives and rapid receptor kinetics complicates reversal of high-affinity opioids. An opioid with high receptor affinity will require greater naloxone concentrations and/or a continuous infusion before reversal sets in compared with an opioid with lower receptor affinity. The clinical approach to severe opioid-induced respiratory depression is to titrate naloxone to effect and continue treatment by continuous infusion until chances for renarcotization have diminished. New approaches to prevent opioid respiratory depression without affecting analgesia have led to the experimental application of serotinine agonists, ampakines, and the antibiotic minocycline.
Dahan
Albert
A
Department of Anesthesiology, Leiden University Medical Center, UK. a.dahan@lumc.nl
Aarts
Leon
L
Smith
Terry W
TW
D002047:Buprenorphine / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008911:Minocycline / Q000627:therapeutic use; D009270:Naloxone / Q000009:adverse effects / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000139:chemically induced* / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D012131:Respiratory Insufficiency / Q000139:chemically induced* / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D018490:Serotonin Agents / Q000627:therapeutic use
D009292:Narcotic Antagonists; D018490:Serotonin Agents; D009270:Naloxone; D002047:Buprenorphine; D008911:Minocycline