title: Dyspnoea associated with anxiety--symptomatic therapy with opioids in combination with lorazepam and its effect on ventilation in palliative care patients.
abstract: OBJECTIVE
  Opioids are used for symptomatic therapy of dyspnoea, and benzodiazepines if dyspnoea is associated with anxiety. When given at the same time, the risk of respiratory depression will increase. The aim of this study was to assess the safety of this treatment regimen in palliative care patients.
  
  
  METHODS
  In a prospective non-randomised study, 26 patients were included. All patients suffered from moderate to severe dyspnoea associated with anxiety. Transcutaneous measurement (tm) of carbon dioxide partial pressure (paCO(2)), pulse oximetry oxygen saturation (SaO(2)) and pulse frequency (PF) were monitored with SenTec Digital Monitor (SenTec AG, Therwill, CH); consecutive measurement of respiratory rate (f). Baseline values at admission, and 30, 60, 90 and 120 min after the first application of the opioid and anxiolytic (O + A) were compared.
  
  
  RESULTS
  Hypoxic and non-hypoxic patients showed no significant paCO(2) increase or SaO(2) decrease after opioid application in combination with lorazepam. At admission, mean SaO(2) was 95.0 ± 4.6 % (85.0-100) and mean paCO(2) was 38.1 ± 6.0 mmHg (26.0-48.0) vs. SaO(2) 95.2 ± 3.5 % (87.0-100.0), paCO(2) 37.7 ± 5.5 (24.0-47.0) 120 min after the first O + A application. Also, f decreased significantly high from 40.6 ± 4.8/min (32.0-50.0/min) to 32.0 ± 4.0/min (20.0-32.0/min; p < 0.001) after 120 min. Furthermore, there was a significant decrease in the intensity of dyspnoea at rest and on exertion (6.2 ± 2.0 (4-10)/7.4 ± 2.3 (4-10) vs. 1.2 ± 0.8 (0-3)/2.5 ± 1.2 (1-5) after 120 min (p < 0.0001)).
  
  
  CONCLUSIONS
  Our results showed that the use of O + A was a safe and effective treatment option in this patient group. Signs of respiratory depression were not found.
authors.affiliation: Department of Science and Research, Centre for Palliative Medicine, University of Bonn, Malteser Krankenhaus Bonn/Rhein-Sieg, Von-Hompesch-Str 1, 53123 Bonn, Germany. katri-elina.clemens@malteser.org
authors.forename: Katri Elina
authors.initials: KE
authors.lastname: Clemens
authors.forename: Eberhard
authors.initials: E
authors.lastname: Klaschik
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D001007:Anxiety / Q000150:complications* / Q000188:drug therapy; D004347:Drug Interactions; D004417:Dyspnea / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005858:Germany; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D008140:Lorazepam / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011446:Prospective Studies; D012119:Respiration / Q000187:drug effects*; D012131:Respiratory Insufficiency / Q000139:chemically induced
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D008140:Lorazepam