Assessment of the Effects of Drugs on Respiration

Jordan, Christopher

doi:10.1093/bja/54.7.763

Cited by 95 publications

(32 citation statements)

References 63 publications

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“…It is evident from our previous study (Catley et al 1985) that postoperative regional anaesthesia was completely free of hypoxic episodes and might prove to be the ideal form of analgesia in the patient with respiratory disease. If opiates are used, particularly with patientdemand analgesia, then it would seem wise to use a monitor of breathing pattern or Sao2 similar to that used in this study (Jordan 1982). The administration of controlled oxygen concentration appears to be beneficial.…”

Section: Methodsmentioning

confidence: 95%

Episodic Postoperative Oxygen Desaturation: The Value of Added Oxygen

et al. 1985

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Summary: Six patients were studied following general anaesthesia for cholecystectomy or hip replacement. Intravenous morphine was given for postoperative pain relief. Continuous measurements were made of breathing pattern and arterial oxygen saturation for a 12-hour period postoperatively. The effect of breathing either air or 28% oxygen for alternate 2-hour periods was examined. There was no significant effect of oxygen on the number of periods of central apnoea, obstructive apnoea or partial upper airways obstruction. The number of episodes of decreases in oxygen saturation to below 80%, associated with these breathing disturbances, was reduced from 59 to zero by the administration of oxygen. There was a gradual improvement in oxygenation whilst breathing air during the 12-hour postoperative period. The administration of oxygen had a beneficial effect on average arterial oxygen saturation.

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Section: Methodsmentioning

confidence: 95%

Episodic Postoperative Oxygen Desaturation: The Value of Added Oxygen

et al. 1985

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“…The incidence of respiratory depression depends on how it is defmed. 71 The incidence of respiratory depression requiring intervention following conventional doses of intrathecal and epidural opioids is approximately 1%, which is the same as that following conventional dosing of intramuscular and intravenous opioids. 32.33,50,66,72 Early respiratory depression oceurs within two hours of injection of opioid.…”

Section: Respiratory Depressionmentioning

confidence: 99%

Side effects of intrathecal and epidural opioids

1995

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“…Apart from the use of anaesthesia [39] and from species differences [16] there are several other possible explanations for these differences.…”

Section: Comparison With Human Studiesmentioning

confidence: 99%

Effect of low-dose acetazolamide on the ventilatory CO2 response during hypoxia in the anaesthetized cat

Wagenaar¹,

Teppema²,

Berkenbosch³

et al. 1998

Eur Respir J

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The carbonic anhydrase inhibitor acetazolamide stimulates ventilation, resulting in an improvement in arterial oxygen tension (Pa,O 2 ) in patients with chronic obstructive pulmonary disease (COPD) or central sleep apnoea syndrome and in those suffering from acute mountain sickness [1][2][3][4][5][6][7][8][9][10]. The ventilatory effect with the drug is believed to be mediated by a metabolic acidosis, induced by inhibition of renal carbonic anhydrase [11][12][13][14]. However, other local effects of acetazolamide could also contribute to the observed ventilatory effects, since carbonic anhydrase is present in several tissues of the pathways involved in the control of breathing. For example, the enzyme is present in the peripheral and possibly also the central chemoreceptors [15][16][17][18], erythrocytes [16] and muscles [19] and in lung as well as brain capillary endothelium [20][21][22]. Usually, acetazolamide is administered in doses which do not completely inhibit red cell carbonic anhydrase. Complete inhibition of erythrocytic carbonic anhydrase occurs at a fractional inhibition >99.8%, for which doses >10 mg·kg -1 acetazolamide are required [16,23]. In COPD patients, this situation would result in impeded washout of CO 2 from the lungs, leading to CO 2 accumulation in the tissues. Such an undesired complication can be avoided by administering small doses, preventing an increase in the arterial to endtidal carbon dioxide tension (Pa-ET,CO 2 ) gradient.In a previous study in anaesthetized cats, it was found that doses of up to 4 mg·kg -1 acetazolamide (i.v.) did not cause a Pa-ET,CO 2 gradient [24]. In the same study the effect of 4 mg·kg -1 acetazolamide on the ventilatory response to CO 2 during normoxaemia was also investigated: utilizing the technique of dynamic end-tidal forcing (DEF) [25], decreases in the CO 2 sensitivities of the peripheral (Sp) and central (Sc) chemoreflex loops and in the apnoeic threshold (extrapolated carbon dioxide tension (PCO 2 ) at zero ventilation) were found. These effects were attributed to a possible direct action of acetazolamide on the peripheral chemoreceptors and to a change in the relation between brain tissue PCO 2 (Pbt,CO 2 ) and arterial PCO 2 (Pa,CO 2 ), due to a possible effect of the drug on cerebral blood flow regulation.Since this previous study was performed during normoxia, its results may not be directly relevant to a situation of hypoxaemia, such as frequently occurs in patients with COPD.During hypoxaemia, both cerebral blood flow and the relative contribution of the peripheral chemoreceptors to total ventilation are different from that in normoxaemia. Therefore, the aim of this study, in anaesthetized cats, was Effect of low-dose acetazolamide on the ventilatory CO 2 response during hypoxia in the anaesthetized cat. M. Wagenaar, L. Teppema, A. Berkenbosch, C. Olievier, H. Folgering. ©ERS Journals Ltd 1998. ABSTRACT: Acetazolamide, a carbonic anhydrase inhibitor, is used in patients with chronic obstructive pulmonary diseases and central sleep apnoea sy...

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Assessment of the Effects of Drugs on Respiration

Cited by 95 publications

References 63 publications

Episodic Postoperative Oxygen Desaturation: The Value of Added Oxygen

Episodic Postoperative Oxygen Desaturation: The Value of Added Oxygen

Side effects of intrathecal and epidural opioids

Effect of low-dose acetazolamide on the ventilatory CO2 response during hypoxia in the anaesthetized cat

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