Profound Increase in Epinephrine Concentration in Plasma and Cardiovascular Stimulation after [micro sign]-Opioid Receptor Blockade in Opioid-addicted Patients during Barbiturate-induced Anesthesia for Acute Detoxification

Kienbaum, Peter; Thürauf, Norbert; Michel, Martin C.; Scherbaum, Norbert; Gastpar, Markus; Peters, Jürgen

doi:10.1097/00000542-199805000-00004

Cited by 97 publications

(39 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[6] PE following naloxone administration has been explained by excessive sympathetic surge leading to massive release of catecholamines in response to pain with displacement of blood from the systemic to the pulmonary bed. [9] Thus, our patient being volume-overloaded, this side effect of naloxone got more pronounced and precipitated PE.…”

Section: Discussionmentioning

confidence: 64%

Naloxone-induced pulmonary edema: A potential cause of postoperative morbidity in laparoscopic donor nephrectomy

et al. 2009

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 64%

Naloxone-induced pulmonary edema: A potential cause of postoperative morbidity in laparoscopic donor nephrectomy

et al. 2009

View full text Add to dashboard Cite

show abstract

“…Questions have arisen regarding the risk of pulmonary edema when using naloxone in opiate dependent patients. The presumed cause of the edema is an adrenergic crisis with a large increase in catecholamines, an effect documented in a study by Kienbaum et al 51 Clonidine blunts the response to this increase in plasma catecholamines and prevents any significant cardiovascular changes. 24 A test dose of naloxone, 1 mg intravenously, is administered.…”

Section: Initiation Of Opioid Withdrawalmentioning

confidence: 95%

“…Full blown withdrawal symptoms with high blood pressures, excessive myoclonus or seizure like behaviour can be controlled with propofol or a barbiturate. 51 Since fluid loss via the gastrointestinal tract can be considerable, adequate fluid replacement may be necessary. 55 A reliable method in assessing the adequacy of withdrawal is the iv reinjection of high dose naloxone (20-30 mg).…”

Section: Initiation Of Opioid Withdrawalmentioning

confidence: 99%

Ultrarapid opiate detoxification: a review

Kaye

Gevirtz

Bosscher

et al. 2003

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

P Pu ur rp po os se e: : This review on ultrarapid detoxification examines the pharmacology, techniques, and efficacy of this potentially promising technique and contrasts it with conventional treatment modalities.S So ou ur rc ce e: : The information found here is derived from experiences at the Texas Tech University, government reports, and peer reviewed journals. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : Incidence and prevalence of heroin use is on the rise. Social and treatment costs suggest that this problem is staggering. Approximately 400,000 patients are enrolled in or are actively seeking methadone therapy. While many of these individuals want to undergo detoxification, traditional techniques, including methadone tapering are usually unsuccessful. The withdrawal syndrome is extremely unpleasant, may be fatal, and deters patients from completing the detoxification process. Ultrarapid detoxification entails general anesthesia in conjunction with large boluses of narcotic antagonists. This combination allows the individual to completely withdraw from the opiate without suffering the discomfort of the withdrawal syndrome. Unless performed properly, this procedure can be dangerous due to the sympathetic outflow. However, with proper support, this danger can be mitigated.C Co on nc cl lu us si io on n: : Ultrarapid opiate detoxification, performed under the proper circumstances, is associated with few adverse events and is relatively comfortable for patients who seek treatment for their addition. Objectif : La présente étude portant sur la désintoxication ultrarapide revoit la pharmacologie, les techniques et l'efficacité de cette technique potentiellement prometteuse et la compare avec les modalités thérapeutiques traditionnelles. Source : Nos informations sont tirées des expériences à la Texas Tech University, des rapports officiels et des journaux scientifiques.

show abstract

“…Additionally, there is strong evidence documenting elevated circulating epinephrine and norepinephrine concentrations after naloxone administration, even in anesthetized subjects [1]. This is most pronounced, in animal models, in the setting of opioid-induced hypercapnea [2].…”

Section: In Replymentioning

confidence: 99%

In Reply: “The Evolution of Recommended Naloxone Dosing for Opioid Overdose by Medical Specialty”

Connors

Nelson

2016

J. Med. Toxicol.

View full text Add to dashboard Cite

In reply:We appreciate the interest of Lombari et al. in our work and agree that naloxone is a very effective antidote for opioid toxicity. Though acute iatrogenic opioid withdrawal in the ED is not typically life-threatening, measures to control an agitated patient, such as chemical or physical restraint or paralysis and intubation, carry significant negative consequences and may utilize valuable resources and risk complications. These further measures may be avoided if a balance can be struck between the reversal of consequential opioid toxicity and the precipitation of opioid withdrawal. To achieve this, we believe the lowest naloxone dose that reverses respiratory depression should be utilized. The optimal dose cannot be predicted because it is impossible to know the exact opioid, the dose used, the timing, or the concomitant exposures for each patient.Behavioral disturbances after iatrogenic acute withdrawal in opioid-dependent patients place both patients and staff at risk. Additionally, there is strong evidence documenting elevated circulating epinephrine and norepinephrine concentrations after naloxone administration, even in anesthetized subjects [1]. This is most pronounced, in animal models, in the setting of opioid-induced hypercapnea [2]. In the opioid toxic ED patient not under general anesthesia, catecholamine release following naloxone may even be more pronounced. The elevated concentrations of catecholamines may worsen pulmonary capillary permeability and have other adverse cardiovascular consequences.The American Heart Association (AHA) recommendation, like many others in our analysis, does not cite data for their recommendation and is likely expert opinion. Further, the recommendation for 0.4 mg IV or 2 mg IN naloxone after initiation of chest compressions is in the setting of cardiac arrest, a much more severe clinical presentation than bradypnea, hypopnea, and respiratory acidosis commonly seen in the ED. Acute withdrawal is an acceptable risk compared to the potential benefit in the former setting. However, the ability to provide oxygenation and ventilation in the ED reduces the need for rapid and complete opioid reversal in patients with the latter set of circumstances.We agree that evidence regarding an initial naloxone dose of 0.04 mg IV is limited. Given the difficulty in prospectively studying this dosing regimen, the extensive use by a substantial number of authors who recommend this approach provides added support for its value. The risk-benefit profile of naloxone today, once under medical care that can provide respiratory support, falls towards a deliberate and cautious approach. There should not be a significant time delay to adequate dosing by starting with a low dose as naloxone can be rapidly titrated with escalating doses.There are over 28,000 opioid deaths annually in the USA, and the number of nonfatal overdoses is obviously much higher. Naloxone will continue to be a widely used tool to reverse opioid toxicity and potentially save lives, and the more we can refine our knowl...

show abstract

Profound Increase in Epinephrine Concentration in Plasma and Cardiovascular Stimulation after [micro sign]-Opioid Receptor Blockade in Opioid-addicted Patients during Barbiturate-induced Anesthesia for Acute Detoxification

Cited by 97 publications

References 29 publications

Naloxone-induced pulmonary edema: A potential cause of postoperative morbidity in laparoscopic donor nephrectomy

Naloxone-induced pulmonary edema: A potential cause of postoperative morbidity in laparoscopic donor nephrectomy

Ultrarapid opiate detoxification: a review

In Reply: “The Evolution of Recommended Naloxone Dosing for Opioid Overdose by Medical Specialty”

Contact Info

Product

Resources

About