The Effects of Naloxone (Narcan) on Circulation and Respiration Following Neurolept-Anaesthesia for Neurosurgery

Huse, K.; Hartung, E.; Nadjmabadi, M. H.; Larcom, Gordon D.

doi:10.1097/00132586-197512000-00014

Cited by 3 publications

(3 citation statements)

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“…Naloxone administration is generally associated with an increase in heart rate, cardiac output and arterial blood pressure in humans and in dogs, 60 and studies in the latter have shown increased coronary blood flow and myocardial oxygen consumption. 61,62 Initially, studies of the administration of high doses of naloxone to patients with OUD under general anesthesia for purposes of detoxification produced no significant changes in heart rate, mean arterial pressure, cardiac index, peripheral resistance or oxygen saturation.…”

Section: Opioid Withdrawalmentioning

confidence: 99%

Naloxone dosage for opioid reversal: current evidence and clinical implications

Lynn

Galinkin

2017

Therapeutic Advances in Drug Safety

264

196

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Current contextOpioid overdoses have quadrupled in the past 15 years, and in 2015 there were over 33,000 opioidrelated deaths in the United States. 1 Opioid overdose induces respiratory depression that can lead to hypoxia, hypercarbia and death. In an attempt to expedite treatment and improve outcomes following overdose, naloxone is increasingly being utilized in a pre-hospital setting by both emergency personnel and prescribed to laypersons for out-of-hospital administration. 2 Efficacy of reversal following naloxone administration by laypersons is high, having been reported at 75-100%, 3 and in general take-home naloxone programs are considered effective for reducing opioid-overdose mortality. 4 Naloxone overall is a safe medication, and is not known to cause harm when administered in typical doses to opioid-naïve patients. [5][6][7][8] There is concern about the precipitation of opioid-withdrawal syndrome following its administration in the setting of prior opioid exposure. Despite the long-standing use of naloxone to reverse the symptoms of opioid overdose or toxicity, appropriate dosing remains controversial, with varying doses recommended over time and by medical specialty. 9 In a hospital setting, this medication is typically administered initially in a low dose, which is then titrated to optimize reversal of opioid-induced respiratory depression while attempting to minimize the risk of withdrawal. 10 In a non-medical setting, the ideal of gradually titrating naloxone to effect is not practical, thus a single standardized initial dose for out-of-hospital naloxone rescue has been sought. This review will evaluate the literature to address the question of optimal naloxone dosing to reverse opioidinduced respiratory depression while minimizing patient risk. HistoryNaloxone was developed in the early 1960s as a novel opioid antagonist with fewer side effects than its predecessors. 11 Naloxone hydrochloride is a competitive mu-opioid receptor antagonist historically used only by trained clinical professionals for the reversal of opioid overdose in an emergency or inpatient setting. It is approved for administration by a variety of routes, including intravenous (IV), intramuscular (IM), subcutaneous (SQ) and intranasal (IN), but is also administered via inhalation following nebulization or endotracheal tube in intubated patients. [12][13][14] Formulations for many other routes of administration are currently under development, including sublingual and buccal. 15 Naloxone is not typically administered orally due Naloxone dosage for opioid reversal: current evidence and clinical implications Rachael Rzasa Lynn and JL Galinkin Abstract: Opioid-related mortality is a growing problem in the United States, and in 2015 there were over 33,000 opioid-related deaths. To combat this mortality trend, naloxone is increasingly being utilized in a pre-hospital setting by emergency personnel and prescribed to laypersons for out-of-hospital administration. With increased utilization of naloxone there has been a subsequent reduc...

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Section: Opioid Withdrawalmentioning

confidence: 99%

Naloxone dosage for opioid reversal: current evidence and clinical implications

Lynn

Galinkin

2017

Therapeutic Advances in Drug Safety

264

196

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“…Significant increases in cardiac work have been shown following narcotic reversal with naloxone. [13][14][15] These authors concluded that a reduced dosage regimen should be adopted for naloxone use. However, Prough et al lo reported the occurrence of pulmonary oedema in two patients given 0.1 mg doses of naloxone.…”

Section: Discussionmentioning

confidence: 99%

A Fatal Case of Pulmonary Oedema in a Healthy Young Male following Naloxone Administration

Wride

Smith

Courtney

1989

Anaesth Intensive Care

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“…There are reports of side effects associated with high-dose naloxone use, including pulmonary edema, cardiac arrhythmias, hypertension, hypotension, and cardiac arrest, although these complications are not often fatal (Rzasa Lynn & Galinkin, 2018). However, the use of naloxone has been shown to increase heart rate, cardiac output and arterial blood pressure (Huse, Hartung, & Nadjmabadi, 1974). People with underlying arrhythmias may be at particular risk for naloxone-induced arrhythmias (Rzasa Lynn & Galinkin, 2018), and the literature reports cardiac arrest in an otherwise healthy person administered 0.2 mg IV naloxone (Andree, 1980).…”

Section: The Role Of Naloxone In Psud Overdosementioning

confidence: 99%

The Challenge of Polysubstance Use Overdose

Pergolizzi¹,

Varrassi²,

LeQuang³

et al. 2021

JSS

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Despite the urgency of the public health crisis of opioid overdose morbidity and mortality, and the widespread intense attention and effort directed toward its elimination, or at least its mitigation, deaths due to drug overdose are on the rise, and in fact are reaching all-time record highs. Fentanyl (real or counterfeit) and its legal and illicit analogs are certainly a major contributor to the problem, but another important driver is the significant increase in polysubstance abuse, which now occurs in the majority of overdose deaths. Polysubstance overdose presents a particular treatment challenge. Overdose victims might not be able to state what drugs they have taken, and if the products were adulterated, they themselves might not even know. Mechanistically, the resultant additive, or even synergistic, interaction between drugs adds a level of complexity above the standard treatment of using a mono-mechanistic receptor antagonist. We review these challenges.

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The Effects of Naloxone (Narcan) on Circulation and Respiration Following Neurolept-Anaesthesia for Neurosurgery

Cited by 3 publications

References 0 publications

Naloxone dosage for opioid reversal: current evidence and clinical implications

Naloxone dosage for opioid reversal: current evidence and clinical implications

A Fatal Case of Pulmonary Oedema in a Healthy Young Male following Naloxone Administration

The Challenge of Polysubstance Use Overdose

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