Analgesic and Respiratory Depressant Activity of Nalbuphine

Gal, Thomas J.; DiFazio, Cosmo A.; Moscicki, Jeffrey C.

doi:10.1097/00000542-198211000-00004

Cited by 185 publications

(66 citation statements)

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“…Normally, the dominant control of ventilation is mediated through an increase in PaCO 2 , which strongly stimulates central chemoreceptors, 119 leading to increased ventilation. RD from morphine is characterized by a dose-related, naloxone-reversible depression of resting minute ventilation (Ve) with proportional reduction of tidal volume (Vt), [120][121][122] decreased PaO 2 and pH, increased PaCO 2 , 121,123 and decreased ventilatory drive stimulated by hypercapnia and hypoxia. 124,125 In volunteers, ITM caused a dose-related depression of medullary respiratory centre sensitivity to ventilatory stimulus.…”

Section: Discussionmentioning

confidence: 99%

Définitions de la “dépression respiratoire” de l’analgésie postopératoire réalisée avec de la morphine intrathécale : une revue documentaire

Goldstein

VanDenKerkhof

2003

Can J Anesth/J Can Anesth

108

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P Pu ur rp po os se e: : To review the postoperative intrathecal morphine (ITM) analgesia literature for their definitions of "respiratory depression" (RD).S So ou ur rc ce e: : Medline (1966 -June Week 5 2001) and reference lists were searched for original studies involving bolus-dose ITM for postoperative analgesia, which used "respiratory depression" or similar terms. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The search identified 209 studies. These were included if ITM use was appropriate (bolus dose, postoperative analgesia) and the term "respiratory depression" was used, which left 96 studies remaining. Forty-four (46%) did not define "RD" despite using this term. A further 24 (25%) defined RD with respiratory rate (RR) alone. Only 28 (29%) defined RD with more than RR alone. There was no statistically significant association between the presence of a definition for RD with study design, study size or publication period. Also, no significant association existed between rigorousness of RD definitions and the above factors.C Co on nc cl lu us si io on n: : The term "respiratory depression" has no clear definition from a review of the literature on ITM use for postoperative analgesia. While defining RD with bradypnea is superior to having no definition, this is still inadequate. In future research, the consistent use of terms with specific meanings will facilitate understanding the true incidence of ITM's respiratory effects. If "respiratory depression" is used, then an explicit definition of its meaning should be provided. Future research must also address what is clinically significant respiratory impairment from intrathecal opioids, and how to optimally monitor for this. Further delineating their risks vs benefits will allow for more optimal dosing. Objectif : Passer en revue les documents sur l'analgésie postopéra-toire, réalisée avec la morphine intrathécale (MIT), quant à leurs défi-nitions de la "dépression respiratoire" (DR). Source : La base Medline (1966 -Semaine 5, juin 2001) et les listes de lectures de référence ont été fouillées à la recherche d'études originales sur des bolus de MIT administrés comme analgésie postopéra-toire, et dans lesquelles on retrouve le terme "dépression respiratoire" ou des termes similaires. Constatations principales : La recherche nous a fourni 209 études. Les études (96) comportant un usage approprié de la MIT (dose en bolus, analgésie postopératoire) et l'utilisation du terme

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Section: Discussionmentioning

confidence: 99%

Définitions de la “dépression respiratoire” de l’analgésie postopératoire réalisée avec de la morphine intrathécale : une revue documentaire

Goldstein

VanDenKerkhof

2003

Can J Anesth/J Can Anesth

108

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“…These features suggest their greatest suitability for routine in-patient ENT and, subject to verification, eye surgery. Nalbuphine has the additional advantages of being a non-controlled drug with low abuse potential, of having a demonstrated safety in clinical practice [64] as a result of a 'ceiling' capacity to depress respiration [65], and of not releasing histamine [23]. Pethidine has the advantage of being the least expensive.…”

Section: Discussionmentioning

confidence: 99%

Analgesics and ENT surgery. A clinical comparison of the intraoperative, recovery and postoperative effects of buprenorphine, diclofenac, fentanyl, morphine, nalbuphine, pethidine and placebo given intravenously with induction of anaesthesia.

Berg

Honjol

Prabhu

et al. 1994

Brit J Clinical Pharma

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1 Vomiting and restlessness following ENT and eye surgery are undesirable, and may be related to the emetic and analgesic effects of any analgesic given to augment anaesthesia during surgery. 2 To rationalise the choice of analgesic for routine ENT surgery we examined the intraoperative, recovery and postoperative effects following the administration of either buprenorphine (3.0 to 4.5 pg kg-'), diclofenac (1 mg kg-'), fentanyl (1.5 to 2.0 pg kg-'), morphine (0.1 to 0.15 mg kg-'), nalbuphine (0.1 to 0.15 mg kg-'), pethidine (1.0 to 1.5 mg kg-') or saline (as control) given with the induction of anaesthesia in 374 patients. A standardised anaesthetic technique with controlled ventilation using 0.6-0.8% isoflurane in nitrous oxide and oxygen was employed. The study population constituted 7 similar groups of patients. 3 Intraoperatively, their effects on heart rate and blood pressure, airway pressure and intraocular pressure, were similar. This implies, most surprisingly, that neither their analgesic nor their histamine releasing effects were clinically evident during surgery. By prolonging the time to extubation at the end of anaesthesia, only buprenorphine, fentanyl, morphine and pethidine provided evidence of intraoperative respiratory depression. 4 Postoperatively, buprenorphine was associated with severe respiratory depression, prolonged somnolence, profound analgesia and the highest emesis rate. Diclofenac exhibited no sedative, analgesic, analgesic sparing, emetic or antipyretic effects. Fentanyl provided no sedative or analgesic effects, but was mildly emetic. Morphine provided poor sedation and analgesia, delayed the requirement for re-medication and was highly emetic. Nalbuphine and pethidine produced sedation with analgesia during recovery, a prolonged time to re-medication and a mild emetic effect. None provided evidence, from analysis of postoperative re-medication times and analgesic consumption, of any pre-emptive analgesic effect.5 We conclude that nalbuphine (mean dose 0.13 mg kg-') and pethidine (mean dose 1.35 mg kg-'), given individually as a single i.v. bolus during induction of anaesthesia, are the most efficacious analgesics for routine in-patient ENT surgery.

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“…At low doses (\0.5 mg kg -1 ), morphine shifts the V E versus PCO 2 response curve to the right without changing its slope. At higher concentrations, the slope of the curve tends to decrease, possibly related to changes in the level of consciousness [84].…”

Section: Opioidsmentioning

confidence: 99%

Sources of Inspiration: A Neurophysiologic Framework for Understanding Anesthetic Effects on Ventilatory Control

Czick

Waldman

Gross

2013

Curr Anesthesiol Rep

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Almost every medication that is presently available to provide sedation, analgesia, or general anesthesia significantly depresses one or more ventilatory control mechanisms. This places patients at risk of developing hypoventilation and hypoxemia during moderate or deep sedation as well as general anesthesia. As the neurophysiologic processes underlying normal ventilatory drive are discovered, new insights into the influence of anesthetics on ventilation have been recognized. More importantly, research into ways to circumvent these effects is underway. For example, drugs such as serotonin agonists and ampakines have been shown to counteract opioidinduced ventilatory depression without reversing the analgesic effect. On the other hand, efforts to identify agents that reverse the respiratory depression associated with propofol and the inhalation anesthetics have been less promising. Until reliable means for reversing drug-induced ventilatory depression are developed, prompt recognition of ventilatory insufficiency and initiation of resuscitative measures remain the keys to patient safety.

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Analgesic and Respiratory Depressant Activity of Nalbuphine

Cited by 185 publications

References 0 publications

Définitions de la “dépression respiratoire” de l’analgésie postopératoire réalisée avec de la morphine intrathécale : une revue documentaire

Définitions de la “dépression respiratoire” de l’analgésie postopératoire réalisée avec de la morphine intrathécale : une revue documentaire

Analgesics and ENT surgery. A clinical comparison of the intraoperative, recovery and postoperative effects of buprenorphine, diclofenac, fentanyl, morphine, nalbuphine, pethidine and placebo given intravenously with induction of anaesthesia.

Sources of Inspiration: A Neurophysiologic Framework for Understanding Anesthetic Effects on Ventilatory Control

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