Prospective, controlled, randomized trial of naloxone infusion in early hyperdynamic septic shock

Effects of Naloxone Infusion in Patients with Septic Shock and Renal Failure: A Limited Experience

“…Based on our observations, as well as on those of pre vious studies [5, [9][10][11][12], it appears safe to administer nal oxone and furosemide in refractory septic shock compli cated by ARF, especially when facilities for continuous arteriovenous hemofiltration (CAVH) are not available and hemodialysis cannot be carried out due to refractory hypotension. In this regard, the following sequence of action could be undertaken: (a) ensure an adequate pul monary capillary wedge pressure of at least 15 mm Hg with isotonic and iso-oncotic fluid replacement; (b) estab lish vasopressor dependency or refractoriness by observ ing the need for escalating dosages of dopamine, norepi nephrine or both within the first 2-3 h after the onset of hypotension; (c) test the response to naloxone by giving 0.8 mg intravenously and documenting a rise in systolic blood pressure of 10 mm Hg or more; (d) give a loading dose of 30 pg/kg of naloxone followed by an infusion of 30 pg/kg/h not to exceed 2 mg/h; (e) if oliguric renal fail ure is documented at the time of evaluation, administer 1 g of furosemide intravenously during the administra tion of naloxone.…”

“…In this regard, other placebo-controlled studies adjusting for some of these variables have consistently demonstrated a beneficial hemodynamic response of naloxone adminis tration when given as a continuous intravenous infusion preceded by a loading dose [9,10]. It has been postulated that the beneficial action of naloxone in shock reversal may be related to a blockade of the inhibitory influence of endorphins on the vasocontrictor action exerted by nor epinephrine or angiotensin as well as to a possible direct inotropic effect on the heart [9,10]. Our limited experi ence does not permit any conclusions in this regard.…”

Rapidly progressive and overwhelming meningococcal septicaemia in a 14 year old girl

“…Reports in the literature are conflicting with some workers reporting improvement in haemodynamic status and a reduced need for inotropes 15,16,17 whilst other reports suggest that naloxone is ineffective 18,19 or even deleterious 20 . Safani et al reported no overall effect of naloxone in improving survival but noted an improved haemodynamic profile in a subgroup of patients, all of whom survived 21 .…”

Pathogenesis and Management of Septic Shock

“…Naloxone, a narcotic antagonist, has been studied in an effort to block endorphins since these may contribute a vasodilatory effect (62)(63). Cyclooxygenase inhibitors, such as ibuprofen, have been studied because the cyclooxygenase pathway produces prostaglandins, thromboxane, and prostacyclin which are thought to contribute to capillary leakage in septic shock.…”