Mechanisms of opioid-induced respiratory depression

Baldo, Brian A.; Rose, Michael

doi:10.1007/s00204-022-03300-7

Cited by 27 publications

(19 citation statements)

References 91 publications

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“…It must be kept in mind that the administration of IROA, even if necessary, may inevitably result in serious adverse events [ 28 ]. We kept in mind that the administration of IROA with FNT during monitored anaesthesia care (MAC) in awake patients without GA was proven to be able to result in dangerous side effects such as chest wall rigidity [ 29 ] with resultant hypoventilation, known as wooden chest syndrome (WCS).…”

Section: Discussionmentioning

confidence: 99%

Adequacy of Anaesthesia for Nociception Detection during Vitreoretinal Surgery

Stasiowski

Pluta

Lyssek-Boroń

et al. 2023

Life

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Vitreoretinal surgery (VRS) is one of the most widely performed precise procedures in ophthalmic surgery; the majority of cases are carried out under regional anaesthesia (RA) only. However, in specific situations (such as when the patient fails to cooperate with the operator for various reasons), general anaesthesia (GA), alone or in combination with GA (combined general–regional anaesthesia, CGR), is the only safe way to perform VRS. While monitoring the efficacy of an intraoperative rescue opioid analgesia (IROA) during surgery (assessing the adequacy of anaesthesia (AoA)) may be challenging, the surgical pleth index (SPI) is a useful tool for detecting the reaction to noxious stimuli and allows for the rational titration of opioid analgesics (AO) during surgery. The current study investigated the influence of the SPI-based titration of fentanyl (FNT) in combination with various pre-emptive analgesia (PA) techniques on intraoperative pain perception during various stages of VRS performed under AoA. A total of 176 patients undergoing VRS under GA were enrolled in the study. They were randomly assigned to one of the five following study arms: Group GA (control group)—patients who received general anaesthesia alone; Group PBB—GA with preprocedural peribulbar block (with 0.5% bupivacaine and 2% lidocaine); Group T—GA with preventive, topical 2% proparacaine; Group M—GA with a preprocedural intravenous infusion of 1.0 g of metamizole; and Group P—GA with a preprocedural intravenous infusion of 1.0 g of paracetamol. The whole procedure was divided in four stages: Stage 1 and 2—preoperative assessment, PA administration, and the induction of GA; Stage 3—intraoperative observation; Stage 4—postoperative observation. the SPI values were monitored during all stages. The occurrence of nociception (expressed as ∆SPI >15) during various manipulations in the surgical field was observed, as were cumulative doses of rescue analgesia, depending on the PA administered. During the course of VRS, rescue FNT doses varied depending on the stage of surgery and the group investigated. The majority of patients, regardless of their group allocation, needed complementary analgesia during trocar insertion, with Group GA patients requiring the highest doses. Likewise, the highest cumulative doses of IROA were noted during endophotocoagulation in Group GA. Preventive PBB and topical anaesthesia were proven to be most efficient in blunting the response to speculum installation, while topical anaesthesia and paracetamol infusion were shown to be more efficient analgesics during endophotocoagulation than other types used PA. In the performed study, none of the PA techniques used were superior to GA with FNT dosing under the SPI with respect to providing efficient analgesia throughout the whole surgery; there was a necessity to administer a rescue OA dose in both the control and investigated groups.

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Section: Discussionmentioning

confidence: 99%

Adequacy of Anaesthesia for Nociception Detection during Vitreoretinal Surgery

Stasiowski

Pluta

Lyssek-Boroń

et al. 2023

Life

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“…It is unknown which locations are required for the induction of opioid-induced respiratory depression because several different sites can independently have a depressing effect on breathing. The preBötzinger complex in the ventrolateral medulla is the source of inspiratory rhythm (12). Patients who use opioids chronically as for more than six months are more likely to develop Biot's respiration, ataxic breathing, or both, which is an erratic breathing pattern accompanied by central apneas during sleep.…”

Section: Respiratory Depression and Sleep Disordersmentioning

confidence: 99%

Common Conditions Associated with Long Term Opioid Usage

Bajabir¹,

Albishri²,

Shaheen³

et al. 2022

JOHS

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Opioids are drugs that are used to manage wide range of chronic painful diseases. They are classified as broadspectrum analgesics. They are frequently prescribed to manage cancer and chronic pain, post-operative pain among certain other conditions. However, there is a well-known phenomenon of psychological addiction that can develop with the use of opioids leading to prolonged use, abuse and misuse which undermines their clinical efficacy associated with their use. Although in some conditions long-term opioid therapy is needed. According to clinical recommendations, long-term opioid therapy involves taking opioids every day for more than three months. The criteria for defining long-term opioid therapy in clinical settings and research, however, vary. Certain conditions are associated with its long-term use including impaired cognitive effects, sedation, constipation, nausea, vomiting, physical dependence, tolerance, and respiratory depression which are quite common with the opioid treatment. Clinical concerns regarding addiction may hinder appropriate prescribing, resulting in insufficient pain management. Delay in stomach emptying, hyperalgesia, immunologic and hormonal abnormalities, muscular rigidity, and myoclonus are examples of less prevalent effects reported with long-term opioid use. Opioid induced constipation is commonly reported in long-term use and may get severe enough to necessitate stopping the opioids and cause underdosing and insufficient analgesia. Respiratory and sleep disorders also frequently observed in longterm users of opioids. Also, incidence of new episode of depression is quite commonly linked to the chronic use of opioid. The purpose of this research is to review the available information about common conditions associated with long term opioid usage.

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“…Given the differential pharmacodynamics and pathophysiology underlying these different types of drugs, it is important to examine their associated overdose mortality separately. Acute overdose mortality caused by MOP-r agonists is primarily attributed to respiratory depression mediated by several brainstem nuclei [26,27]. Ascribed in part to greater rapidity of onset or chest rigidity, recent studies suggest that fentanyl may pose greater overdose risk than heroin or morphine derivatives [28][29][30].…”

Section: Introductionmentioning

confidence: 99%

Overdose mortality rates for opioids or stimulants are higher in males than females, controlling for rates of drug misuse: State-level data

Butelman¹,

Huang²,

Goldstein³

et al. 2023

Preprint

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Drug overdoses are an escalating cause of mortality in the United States, with potential sex differences across the lifespan. The objective of this study was to use state-level nationally representative data that includes the COVID-19 pandemic period to determine overdose mortality for specific drug categories across the lifespan of men and women. We used Centers for Disease Control and Prevention (CDC) Multiple Cause of Death 2020-2021 data on overdose mortality, for 50 states and District of Columbia, across 10-year age bins (age range: 15-74). The outcome measure was sex-specific crude overdose death rate (per 100,000) for: synthetic opioids excluding methadone (ICD-10 code: T40.4; e.g., fentanyl), heroin (T40.1), psychostimulants with abuse potential (T43.6; e.g., methamphetamine), and cocaine (T40.5). Multiple regression analyses adjusted for ethnic-cultural background and household net worth from Census data, and sex-specific rate of misuse of the relevant substances, from the National Survey on Drug Use and Health (2019-2020). For each of these major drug categories, men had greater overall overdose mortality than women. Although overall rates of mortality differed across jurisdictions, the sex ratio of mortality for each drug category was relatively stable (≈2- to 3-fold greater mortality in men vs women). These findings survived adjustment for state-level ethnic-cultural and economic variables, and for sex-specific misuse of each drug type (especially in the 25-34, 35-44, 45-54 and 55-64 age bins). These findings underscore the need for research into sex- and gender-based mechanisms underlying differential vulnerability in overdose mortality for these drugs, based on their diverse pharmacodynamics and pathophysiology.

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Mechanisms of opioid-induced respiratory depression

Cited by 27 publications

References 91 publications

Adequacy of Anaesthesia for Nociception Detection during Vitreoretinal Surgery

Adequacy of Anaesthesia for Nociception Detection during Vitreoretinal Surgery

Common Conditions Associated with Long Term Opioid Usage

Overdose mortality rates for opioids or stimulants are higher in males than females, controlling for rates of drug misuse: State-level data

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