Pulmonary Edema Following Naloxone Administration in a Patient Without Heart Disease

Morphine-induced acute lung injury

“…Although the summary of product characteristics for morphine points out that "noncardiogenic pulmonary edema has been observed in intensive-care patients," very few reports about this issue can be found in the scientific literature [1,2]. In addition to opioid-induced acute lung injury (ALI), there are a number of publications on the occurrence of pulmonary edema after heroin intoxication and administration of naloxone and buprenorphine [3][4][5][6][7][8][9][10][11]. The exact mechanisms of these effects are not yet fully understood; opioid-induced ALI occurring approximately two to 4 hours after drug intake is characterized by dyspnea, significant hypoxia, and bilateral infiltrates [12].…”

Naloxone reversal of opioid anesthesia revisited: clinical evaluation and plasma concentration analysis of continuous naloxone infusion after anesthesia with high-dose fentanyl

“…However, it might be more difficult to terminate naloxone infusion with the appropriate timing in patients who show no specific symptoms. The obtained pharmacokinetic profiles revealed that the plasma fentanyl levels remained at 5 (3)(4)(5)(6)(7)(8) ng·ml Ϫ1 during the first 4 h. Therefore, the 25% reduction of the naloxone rate during this 4-h period might have been done too early, at least in some patients, although none of the patients in this study, developed respiratory depression after decreasing of the rate. Because the plasma fentanyl levels were calculated to have decreased to less than 2 ng·ml Ϫ1 after 13 Ϯ 5 h, we assume that naloxone can be terminated without the risk of renarcotization in most patients by the morning of the second POD at the dose range of fentanyl used in the present study.…”

“…Naloxone, at a clinically relevant single dose, effectively normalizes the depressed respiration even when it is caused by very high doses of opioids [7]. However, postoperative naloxone use can involve several adverse effects, including renarcotization due to the short duration of action of this agent, and symptoms that are, presumably, related to "acute abstinence" from the opioid effects, such as pain, psychological stimulation, or sympathomimetic responses, of which the most severe is pulmonary edema [7][8][9]. To avoid such disadvantages, several studies have previously evaluated the effectiveness of continuous naloxone infusion after high-dose opioid anesthesia [10][11][12].…”

Complications of Ultrarapid Opioid Detoxification with Subcutaneous Naltrexone Pellets

“…[17][18][19][20] A limited number of reports also suggest that the use of naloxone may be associated with pulmonary edema, perhaps due to the excessive release of catecholamines during unrecognized hypercarbia from hypoventilation. 21,22 Of note, these two reports of pulmonary edema were associated with the use of general anesthesia-a scenario similar to UROD in that the patient is mechanically ventilated and given general anesthetics in both situations. This is in contradistinction to the typical use of naloxone by clinicians attempting to reverse the opioid toxidrome.…”