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Topic: Respiratory depression

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Miosis

Orthostatic hypotension

Codeine

Manic depression

Depression

International Nonproprietary Name

Turfan Depression

	Respiratory Depression
		Occasionally, respiratory depression occurs when pain is abruptly relieved and the sedative effects of opioids are no longer opposed by the stimulating effects of pain.
		Far more common than acute respiratory depression is subacute overdose, in which sedation gradually builds and is followed by a slowing of respiratory rate and then by ventilatory failure.
		Respiratory depression is not often a significant limiting factor in pain management because, with repeated doses, tolerance develops to this effect, allowing for adequate pain treatment with escalating doses without respiratory compromise.
	www.hivpositive.com /f-PainHIV/Pain/LS3.3.4.4.html (545 words)

	[No title]
		For PCA, the mean (95% CI) reported incidence of respiratory depression varied between 1.2% (0.7% to 1.9%) and 11.5% (5.6% to 22.0%), using hypoventilation and oxygen desaturation, respectively, as indicators.
		For epidural analgesia, the mean (95% CI) reported incidence of respiratory depression varied between 1.1% (0.6% to 1.9%) and 15.1% (5.6% to 34.8%), using hypoventilation and oxygen desaturation, respectively, as indicators.
		The authors conclude that, assuming that a mixture of analgesic techniques is used, an incidence of respiratory depression, as defined by a low ventilatory frequency, of less than 1% would be expected, and an incidence of hypotension related to analgesic technique of less than 5%.
	www.frca.co.uk /JournalView.aspx?jid=66 (348 words)

	The Double Effect of Pain Medication
		Although a review of the medical literature reveals that the risk of respiratory depression from opioid analgesic is more myth than fact and that there is little evidence that the use of medication to control pain hastens death, the belief in the double effect of pain medication remains widespread.
		Because respiratory depression is potentially life threatening, it is considered the most serious opioid side effect and is of great concern to physicians and nurses.
		Hill noted that the fear of respiratory depression is "greatly exaggerated" and "rarely occurs in patients with severe pain." When respiratory depression occurs, it usually is in "opioid-naive patients after acute administration of an opioid" and is accompanied by sedation or mental confusion.
	www.cpmission.com /main/double.html (6863 words)

	Data Sheet
		The respiratory depressant properties of fentanyl appear to be due to a central effect by decreasing the sensitivity of the respiratory centre to carbon dioxide.
		Duration and degree of respiratory depression is dose-related.
		Respiratory depression is more likely to occur with intravenous administration if a dose is given too rapidly and it rarely occurs with intramuscular administration.
	www.medsafe.govt.nz /Profs/Datasheet/f/FentanylcitrateinjUSP.htm (2968 words)

	Untitled Document
		Constipation, nausea, vomiting, sedation and respiratory depression are potential side effects of opioid analgesics.
		Clinically significant respiratory depression (less than 7 breaths per minute in an adult) occurs less often when opioids are given by the epidural route or by intravenous patient controlled analgesia than when given by the intramuscular route.
		Because tolerance to respiratory depression occurs over a period of days to weeks, the patients at highest risk are "opioid naive" patients – individuals who have not previously received opioid drugs and now, due often to trauma or surgery, receive regular daily doses of opioids.
	www.rnceus.com /ages/side.htm (569 words)

	Opioids and Respiratory Depression (Site not responding. Last check: 2007-10-22)
		Nearly all experienced respiratory care practitioners have witnessed opioid-induced respiratory depression in the intensive care unit, or have been summoned to the postanesthesia care unit to provide support for respiratory failure caused by opioids.
		Respiratory depression by opioids is dose-related; however, the response to a given dose is quite variable among patients.
		Antagonism of postoperative opioid-induced respiratory depression: nalbuphine versus naloxone.
	www.rcjournal.com /contents/01.99/01.99.078.asp (1359 words)

	Respiratory depression from neuraxial opioids (Site not responding. Last check: 2007-10-22)
		However, respiratory depression although not common, is a recognizable complication of this technique.
		CSF morphine concentration remains high due to prolonged elimination (7) and cephalad spread to the medullary respiratory center is probably the cause of late respiratory depression.
		Respiratory depression and other systemic effects have been treated with a low dose of naloxone such that epidural analgesia is not reversed.
	www.manbit.com /oa/C90.htm (504 words)

	IASP Newsletter Technical Corner: Respiratory Effects of Opioids
		Although serious complications or deaths from opioid-induced respiratory depression are rare, the risk is not zero, and a death or neurologic injury for a patient with an otherwise treatable illness is a great tragedy.
		Depression of cough reflex and airway irritability is also a useful effect of opioids in patients undergoing fiberoptic bronchoscopy and esophagoscopy.
		Respiratory depression requiring naloxone was noted in 45 of 49,183 patients who received epidural opioids (0.09%); 33 of these patients had received morphine (Rawal and Allvin 1996).
	www.iasp-pain.org /TC97JulyAug.html (2732 words)

	NursingCenter - Professional Development - CE Article (Site not responding. Last check: 2007-10-22)
		Respiratory depression has also been defined by decreases in oxygen saturation as measured by pulse oximeter (Parker, Holtman, & White, 1991 ; Sidebotham et al., 1997 ; Tsui et al., 1997).
		Respiratory depression was related to obesity in one study (Fleming & Coombs, 1992).
		Although McCaffery and Pasero (1999) define respiratory depression as a decrease in rate and depth from baseline, this may be difficult to determine for acute care nurses on postoperative units.
	www.nursingcenter.com /prodev/ce_article.asp?tid=484922 (4746 words)

	Respiratory depression in the acute management of seizures -- Stewart et al. 87 (3): 225 -- Archives of Disease in ...
		Respiratory depression in the acute management of seizures -- Stewart et al.
		Respiratory depression in the acute management of seizures
		Respiratory depression in children receiving diazepam for acute seizures: a prospective study.
	adc.bmjjournals.com /cgi/content/full/87/3/225 (727 words)

	Drug-Induced Respiratory Depression
		Whenever a respiratory depressant is dispensed, it is vitally important to assess the patient’s medication profile to check for agents with alcohol in the formulation.
		Tolerance to the respiratory depressant effect, as with the analgesic effect, is seen over time for all opioids and allows for dosage escalation when the patient begins to experience breakthrough pain without concern for inducing respiratory depression.
		Finally, zolpidem may have less respiratory depressant effects than benzodiazepines, but the dosage should be reduced to 5 mg in elderly or debilitated patients and doses greater than 20 mg should be avoided in all patients.
	www.uspharmacist.com /oldformat.asp?url=newlook/files/Feat/ACF2ECE.cfm&pub_id=8&article_id=17 (3040 words)

	Effects of morphine and respiratory depression on sulfobromophthalein disposition in rats.
		Effects of morphine and respiratory depression on sulfobromophthalein disposition in rats.
		Thus, respiratory depression with hypoxia may contribute to morphine-induced effects on BSP disposition, but altered blood gases cannot account fully for these narcotic effects.
		Similar hypoxia and hypercapnia caused by breathing 9% O2 and 8% CO2 in the absence of morphine caused plasma BSP clearance to be decreased to 4.4 +/- 0.2 ml X min-1 and 40-min hepatic BSP to be increased to 292.5 +/- 31.8 micrograms X g-1.
	www.ihop-net.org /UniPub/iHOP/gp/4804863.html (333 words)

	eMedicine - Respiratory Acidosis : Article by Jackie A Hayes, MD, FCCP
		Hypercapnia and respiratory acidosis occur when impairment in ventilation occurs and the removal of CO by the lungs is less than the production of CO in the tissues.
		This failure in ventilation may be caused by depression of the central respiratory center by cerebral disease or drugs, inability to ventilate adequately due to neuromuscular disease (eg, myasthenia gravis, amyotrophic lateral sclerosis, Guillain-Barré syndrome, muscular dystrophy), or airway obstruction related to asthma or chronic obstructive pulmonary disease (COPD) exacerbation.
		Chronic respiratory acidosis also may be secondary to obesity hypoventilation syndrome (ie, pickwickian syndrome), neuromuscular disorders such as amyotrophic lateral sclerosis, and severe restrictive ventilatory defects as observed in interstitial fibrosis and thoracic deformities.
	www.emedicine.com /med/topic2008.htm (3737 words)

	Mechanisms regulating hypoxic respiratory depression during fetal and postnatal life -- Bissonnette 278 (6): 1391 -- ...
		Foetal respiratory movements, electrocortical and cardiovascular responses to hypoxaemia and hypercapnia in sheep.
		Maturation of the respiratory response to acute hypoxia in the newborn rat.
		Excitatory amino-acid receptors contribute to carotid sinus and vagus nerve evoked excitation of neurons in the nucleus of the tractus solitarius.
	ajpregu.physiology.org /cgi/content/full/278/6/R1391 (6047 words)

	Tramadol
		Respiratory depression and constipation are less common with tramadol and less pronounced than with other opioids.
		Respiratory depression with tramadol is less pronounced, and occurs less often, in comparison to equianalgesic doses of morphine.
		Hence, although respiratory depression in overdose can be treated with the opioid antagonist, naloxone, reversal of all opioid poisoning should be conducted with low doses, repeated as clinically indicated, to avoid rebound effects including pain, hypertension, tachycardia and seizures.
	www.medsafe.govt.nz /Profs/PUarticles/tramadol.htm (1556 words)

	[No title] (Site not responding. Last check: 2007-10-22)
		For detection of potential respiratory depression associated with the administration of narcotic analgesics, a system which indicates a patient's respiratory and cardiac status without the need to invasively measure or sample the patient's blood is particularly desirable and useful.
		The system of the present invention, upon detection and recognition of respiratory depression by the pulse oximetry unit, automatically and immediately shuts-off the PCA unit, sounds visual and audio alarms, as well as delivers appropriate feedback to appropriate medical personnel.
		For additional precaution to further prevent respiratory and central nervous system depression and as an alternative embodiment of the present invention, system 10 or PCA unit 150A may require the clinician to enter patient request dosing limits, such as maximum dose per hour or per 24-hour period.
	www.wipo.int /cgi-pct/guest/getbykey5?KEY=98/19734.980827&ELEMENT_SET=DECL (4293 words)

	ARCHI - Helping Nurses to Recognise and Manage Respiratory Depression (Site not responding. Last check: 2007-10-22)
		Epidural analgesia is routine for some large operative procedures and carries with it significant risks, such as respiratory depression.
		Although nurses can administer Narcan (an opioid antagonist used to reverse the effects of respiratory depression), according to specific criteria, many do not feel confident in administering this drug, and rely on medical instruction to do so.
		Large group training in opioid-induced respiratory depression using the HPS, which involved early recognition of signs and symptoms of opioid-induced respiratory depression and the correct administration of Narcan.
	www.archi.net.au /content/index.phtml/itemId/119138/fromItemId/117541 (910 words)

	Reversal of Morphine-Induced Apnea in the Anesthetized Rat by Drugs that Activate 5-Hydroxytryptamine1A Receptors -- ...
		The endpoint used to detect a respiratory effect of the drugs studied was diaphragmatic electromyogram activity.
		of brainstem raphe neurons causes depression of respiration and
		Florez J, Delgado G and Armijo JA (1972) Adrenergic and serotonergic mechanisms in morphine-induced respiratory depression.
	jpet.aspetjournals.org /cgi/content/full/292/2/704 (5410 words)

	The Double Effect of Pain Medication: Separating Myth from Reality
		The principle of double effect is used to justify the administration of medication to relieve pain even though it may lead to the unintended, although foreseen, consequence of hastening death by causing respiratory depression.
		Hill noted that the fear of respiratory depression is "greatly exaggerateand and "rarely occurs in patients with severe pain." When respiratory depression occurs, it usually is in "opioid-naive patients after acute administration of an opioid" and is accompanied by sedation or mental confusion.
		When respiratory depression occurs, it is usually in opioid-naive patients following acute administration of an opioid and is associated with other signs of CNS depression including sedation and mental clouding.
	www.hospicecare.com /Ethics/fohrdoc.htm (7866 words)

	NMDA Receptor Activity In Utero Averts Respiratory Depression and Anomalous Long-Term Depression in Newborn Mice -- ...
		Respiratory chemoreflex was assessed by exposing the animal to air enriched with 5% CO for ~10 min and recording the steady-state
		This is in contrast to the depressed respiratory rhythm in the NR1
		LTD in NTS and respiratory depression in the newborn mutant animal.
	www.jneurosci.org /cgi/content/full/20/9/RC73 (3846 words)

	[No title]
		Benzodiazepines cause CNS and respiratory depression; administration with other drugs* which also have these effects increases the risk of these effects; monitor clinical effects and reduce benzodiazepine dose if appropriate.
		–inhibits metabolism of midazolam prolonging its sedative and respiratory depressant effects; reduce midazolam dose (possibly to one-quarter) and monitor clinical effect.
		–inhibits the metabolism of triazolam and may increase its sedative and respiratory depressant effects; avoid combination or decrease triazolam dose to a quarter to a half usual dose and monitor clinical effect.
	amh.hcn.net.au /interactions/iddi521c0d.htm (1547 words)

	Differential Effects of Naltrindole on Morphine-Induced Tolerance and Physical Dependence in Rats -- Hepburn et al. 281 ...
		Respiratory depression was measured 48 hr after pellet implantation and an acute challenge with morphine.
		Pazos, A. and Florez, J.: A comparative study in rats of the respiratory depression and analgesia induced by mu and delta agonists.
		Shook, J. Watkins, W. and Camporesi, E. Differential roles of opioid receptors in respiration, respiratory disease, and opiate-induced respiratory depression.
	jpet.aspetjournals.org /cgi/content/full/281/3/1350 (4427 words)

	Definitions of "respiratory depression" with intrathecal morphine postoperative analgesia: a review of the literature: ...
		Definitions of "respiratory depression" with intrathecal morphine postoperative analgesia: a review of the literature: [Definitions de la "depression respiratoire" de l'analgesie postoperatoire realisee avec de la morphine intrathecale : une revue documentaire] -- Ko et al.
		Differential roles of opioid receptors in respiration, respiratory disease, and opiate-induced respiratory depression.
		Respiratory and circulatory effects of intravenous butorphanol and morphine.
	www.cja-jca.org /cgi/content/full/50/7/679 (3698 words)

	Go Seek It respiratory depression
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	www.go-seekit.com /depression/respiratory-depression.htm (158 words)

	Glycyl-glutamine inhibits the respiratory depression, but not the antinociception, produced by morphine -- Owen et al. ...
		Glycyl-glutamine inhibits the respiratory depression, but not the antinociception, produced by morphine -- Owen et al.
		Gly-Gln's specificity for the respiratory and cardiovascular effects of morphine is consistent with evidence that it is preferentially
		The kappa opioid agonist U-50,488H antagonizes the respiratory effects of mu opioid receptor agonists in conscious rats.
	ajpregu.physiology.org /cgi/content/full/279/5/R1944 (2408 words)

	AAN: Diastat (Diazepam Rectal Gel) Does Not Produce Respiratory Depression In Epileptics (Site not responding. Last check: 2007-10-22)
		All patients had been prescribed diazepam rectal gel and the agent was administered based on the manufacturer's recommended dose of 0.5 mg/kg to a maximum single dose of 20 mg.
		No episodes of clinical respiratory depression were associated with the use of diazepam rectal gel.
		She added that additional research regarding the effect of diazepam rectal gel on respiratory response is warranted.
	www.docguide.com /dg.nsf/PrintPrint/69E8B4D1F9E047FC85256A480043C5BE (373 words)

	The effects of a nonsteroidal antiinflammatory drug (ketoprofen) on morphine respiratory depression: a double-blind, ...
		The effects of a nonsteroidal antiinflammatory drug (ketoprofen) on morphine respiratory depression: a double-blind, randomized study in volunteers -- Moren et al.
		The effects of a nonsteroidal antiinflammatory drug (ketoprofen) on morphine respiratory depression: a double-blind, randomized study in volunteers
		respiratory depression was less marked with the combination of drugs than
	www.anesthesia-analgesia.org /cgi/content/abstract/85/2/400 (322 words)

	Physostigmine antagonizes morphine-induced respiratory depression but not analgesia in dogs and rabbits -- Weinstock et ...
		Physostigmine antagonizes morphine-induced respiratory depression but not analgesia in dogs and rabbits -- Weinstock et al.
		decreased the respiratory frequency by 47%, and increased PaCO2 by 47%.
		depression by prolonging the effect of acetylcholine released from
	bja.oxfordjournals.org /cgi/content/abstract/52/12/1171 (241 words)

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