Investigation of Doxapram as a Postanesthetic Respiratory Stimulant

Doxapram shortens recovery following sevoflurane anesthesia

“…In the 1970s and up to the 1980s doxapram was not infrequently used as an analeptic antagonizing the hypnotic and/or respiratory depressant effects of sedatives such as diazepam, opioids, barbiturates and inhalation anesthetics commonly used at that time. 10,14,15 With the introduction of selective antagonist drugs it is now well recognized that antagonism of opioids should be achieved with either naloxone or naltrexone, and antagonism of benzodiazepines can be achieved with flumazenil. However, there is a paucity of useful agents with reasonable safety profiles to antagonize the CNS depressant effects of inhalational anesthetics.…”

“…7,9,10 More recently, Rosenberg et al described the response of a doxapram infusion in an elderly patient following a laparotomy. The patient suffered a cerebrovascular accident, which the authors postulated may have been related to doxapram administration.…”

“…For our investigation, we elected to use a modest single dose of doxapram 1 mg·kg -1 which had previously been shown to be effective in reversing anesthetic effects, without adverse responses. [7][8][9][10] However, benefits must always be weighed against potential risks, and we would only consider using small doses of doxapram in patients where recovery from inhalational anesthesia is unexpectedly prolonged.…”

“…[1][2][3][4][5] In addition, doxapram is also a central nervous system (CNS) stimulant and has been shown to hasten the recovery from general anesthesia with barbiturates, ether, cyclopropane, halothane and methoxyflurane. [6][7][8][9][10] However, its effect on sevoflurane, an inhalation anesthetic with a low blood/gas solubility coefficient and rapid recovery, has not been determined. Furthermore, the effect of doxapram on bispectral index (BIS), a widely used clinical monitor for objectively evaluating the hypnotic effect of anesthesia 11,12 and the early recovery phase of sevoflurane anesthesia, is also unknown.…”

A New Look at the Respiratory Stimulant Doxapram

“…One of the first investigations of its clinical use in humans was that of Stephen and Talton at Duke University (51). They found that, while doxapram had minor respiratory effect on patients given spinal anesthesia alone, it substantially increased respiratory rate and tidal volume in patients anesthetized with potent inhalational anesthetics (halothane, cyclopropane, ether, or methoxyflurane).…”