Effect of Naloxone Reversal on CO₂ Output, Oxygen Uptake and Cardiac Index During Recovery from Fentanyl‐Supplemented Anaesthesia

Abstract

For reversal of contingent residual narcotic depression after fentanyl administration during balanced anaesthesia, the effect of 0.08 mg of naloxone on GOz output, O2 uptake and cardiac index was studied immediately after extubation. This dose maintained normocapnia (5.7 kPa) during early recovery, while in the control group slight hypercapnia was present (6.0 kPa). No significant differences, however, could be detected between the groups in GO2 output, O2 uptake or cardiac index. When 0.16 mg of naloxone was given to six other patients 10 min after the anaesthesia, when spontaneous respiration had stabilized on the same level as in the control group, significant increases in respiratory minute volume and rate and GO2 output were recorded as compared with the respective prenaloxone levels. O2 uptake increased with simultaneous improvement of Pao, and the cardiac index also increased significantly. A slight but highly significant increase in GO2 output was detected after 0.16 mg of naloxone in six patients during anaesthesia and volume-controlled IPPV. A significant increase in Pacoz was also measured. These findings indicate that if naloxone is used postoperatively, a significant metabolic increase may take place due to increased muscular work, restlessness and shivering. Ventilation and cardiac output were adequate for demand under present conditions using 2 pg/kg of naloxone, but careful titration of naloxone is recommended in order to avoid harmful metabolic changes.

Cardiorespiratory Effects of Naloxone in Children

“…2 Increases in heart rate and blood pressure were also noted and are consistent with previous reports. 12, 13 In one study, a significant and prompt increase in heart rate, cardiac index, and cardiac work in response to naloxone was noted. 12 Another trial observed an increase in cardiac index following administration of naloxone and attributed this to the increased work generated by the heart after improved ventilation that followed naloxone reversal of opioid effects.…”

“…12 Another trial observed an increase in cardiac index following administration of naloxone and attributed this to the increased work generated by the heart after improved ventilation that followed naloxone reversal of opioid effects. 13 The increase in heart rate and blood pressure following administration of naloxone has been attributed to catecholamine release. 12, 13 Excess catecholamine release following naloxone administration has been implicated in the development of serious adverse effects such as arrhythmias, pulmonary edema, and cardiac arrest.…”

“…13 The increase in heart rate and blood pressure following administration of naloxone has been attributed to catecholamine release. 12, 13 Excess catecholamine release following naloxone administration has been implicated in the development of serious adverse effects such as arrhythmias, pulmonary edema, and cardiac arrest. 8,10 These complications have been reported primarily in adults in anecdotal case reports.…”

Naloxone dosage for opioid reversal: current evidence and clinical implications

“…[64][65][66] In the post-operative period, Tigerstedt and Tammisto observed that when patients were given 0.08 mg naloxone after anesthesia with fentanyl, there were no significant differences between the naloxone and control groups in CO 2 output, O 2 uptake or cardiac index. 67 However when 0.16 mg of naloxone was similarly administered to patients 10 min after fentanyl-supplemented balanced anesthesia, there were significant increases in respiratory rate, minute volume, CO 2 output and O 2 uptake, as well as an increase in the cardiac index, thought to reflect a metabolic increase that may not be tolerated in all patients, thus careful titration was recommended.…”

A Fatal Case of Pulmonary Oedema in a Healthy Young Male following Naloxone Administration

“…Significant increases in cardiac work have been shown following narcotic reversal with naloxone. [13][14][15] These authors concluded that a reduced dosage regimen should be adopted for naloxone use. However, Prough et al lo reported the occurrence of pulmonary oedema in two patients given 0.1 mg doses of naloxone.…”