The Use of Narcotic Antagonists in Anaesthesia

Abstract

SUMMARY The effects of the opiate antagonists are briefly described. A detailed account is then given of the use of these antagonists in pre‐ and postoperative medication and in anaesthesia. Finally, the value of the antagonists in the treatment of opiate overdosage is discussed.

Analgesic effectiveness of the narcotic agonist‐antagonists.

“…Subsequently, many combinations of nalorphine and levallorphan with morphine, levorphanol, meperidine, alphaprodine, anileridine, oxymorphone and other narcotic analgesics were used as general anaesthetic supplements and for the control of post-operative pain. Reports of their effectiveness have, however, been conflicting (Swerdlow, 1964), and more recent efforts have concentrated on finding the desired characteristics within a single drug. Lasagna & Beecher (1954) were the first to recognize and report that nalorphine had analgesic properties in man.…”

“…Nevertheless, naloxone has been used in narcoticanalgesic mixtures on the premise (Foldes, 1964) (Swerdlow, 1964), but whether there are, in fact, substantial differences in sensitivity to competitive antagonists of neuronal systems subserving most of the undesired, as opposed to the analgesic, effects of narcotics remains to be proved.…”

“…As Swerdlow (1964) has cautioned, there are appreciable risks of complications when combining these drugs with substantial differences in potency and duration of action which may be additionally influenced by the patient's physical status and previous exposure to other narcotics. For example, it is well established that physical dependence to narcotics produces a heightened sensitivity to antagonists (Jaffe & Martin, 1975), and it is also well known that altered physical states, such as drug-or sleep-induced hypercapnia, can result in transient but sometimes misleading 'overshoot' phenomena when antagonists are given (Landmesser et al, 1953;Lambertson, 1964).…”