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Opioid-induced respiratory depression: clinical aspects and pathophysiology of the respiratory network effects.
Am J Physiol Lung Cell Mol Physiol
December 2024
The author is retired. The positions and affiliations are those prior to his retirement.
Important insights and consensus remain lacking for risk prediction of opioid-induced respiratory depression (OIRD), reversal of respiratory depression (RD), the pathophysiology of OIRD, and which sites make the most significant contribution to its induction. The ventilatory response to inhaled carbon dioxide is the most sensitive biomarker of OIRD. To accurately predict respiratory depression (RD), a multivariant RD prospective trial using continuous capnograph and oximetry examining 5 independent variables: age ≥60, sex, opioid naivety, sleep disorders, and chronic heart failure (PRODIGY trial), was undertaken.
View Article and Find Full Text PDFScreening and Perioperative Management of Obesity Hypoventilation Syndrome.
J Clin Med
August 2024
Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, Toronto, ON M5T 2S8, Canada.
Article Synopsis
- - Obesity hypoventilation syndrome (OHS) is often underdiagnosed and presents significant risks during surgery due to associated health problems like hypertension and heart conditions.
- - Patients with OHS face serious postoperative complications, including respiratory failure and difficulties with intubation, making preoperative screening crucial.
- - The review aims to improve awareness and management of OHS among healthcare professionals involved in the care of obese patients undergoing elective surgery.
Mitigating and preventing perioperative opioid-related harm.
Curr Opin Anaesthesiol
December 2024
Department of Anesthesiology, Olive View-UCLA Medical Center, Los Angeles, California, USA.
Purpose Of Review: Although necessary for treatment of acute pain, opioids are associated with significant harm in the perioperative period and further intervention is necessary perioperatively to mitigate opioid-related harm.
Recent Findings: Opioid-naive patients are often first exposed to opioids when undergoing surgery, which can result in significant harm. Despite their benefits in reducing acute postsurgical pain, they are also associated with risks ranging from mild (e.
Postoperative pain trajectory and opioid requirements after laparoscopic bariatric surgery: a single-centre historical cohort study.
Can J Anaesth
November 2024
Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada.
Purpose: Concerns around delayed emergence and opioid-induced ventilatory impairment in bariatric surgery can lead to intraoperative reliance on short-acting opioids and avoidance of long-acting analgesics with potential sedative effects. Nevertheless, an overly-conservative intraoperative analgesic strategy may result in significant pain at emergence and higher opioid requirements in later phases of care. We sought to establish the pattern of intraoperative analgesic use in bariatric surgical patients as well as their postoperative pain trajectory and opioid requirements.
View Article and Find Full Text PDFTropine exacerbates the ventilatory depressant actions of fentanyl in freely-moving rats.
Front Pharmacol
June 2024
Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States.
Our lab is investigating the efficacy profiles of tropine analogs against opioid-induced respiratory depression. The companion manuscript reports that the cell-permeant tropeine, tropine ester (Ibutropin), produces a rapid and sustained reversal of the deleterious actions of fentanyl on breathing, alveolar-arterial (A-a) gradient (i.e.
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