The Influence of Doxapram on Postoperative Pulmonary Function in Patients Undergoing Upper Abdominal Surgery

Lees, Nick; Howie, H.; Mellon, A; McKee, Andrew; Mcdiarmid, I.A.

doi:10.1093/bja/48.12.1197

Cited by 13 publications

(3 citation statements)

References 6 publications

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“…Numerous animal and human studies in the 1970s confirmed that doxapram improves arousal and level of consciousness following anesthesia induced by barbiturates, volatile anesthetics, nitrous oxide and benzodiazepines. A doxapram infusion improved oxygenation and reduced the incidence of pulmonary complications in patients recovering from upper and lower abdominal surgery (14,19,30). Doxapram also increased arousal and shortened recovery time in patients having outpatient surgery (44).…”

Section: Post-anesthesiamentioning

confidence: 99%

A New Look at the Respiratory Stimulant Doxapram

2006

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A number of life-threatening clinical disorders may be amenable to treatment with a drug that can stimulate respiratory drive. These include acute respiratory failure secondary to chronic obstructive pulmonary disease, post-anesthetic respiratory depression, and apnea of prematurity. Doxapram has been available for over forty years for the treatment of these conditions and it has a low side effect profile compared to other available agents. Generally though, the use of doxapram has been limited to these clinical niches involving patients in the intensive care, post-anesthesia care and neonatal intensive care units. Recent basic science studies have made considerable progress in understanding the molecular mechanism of doxapram's respiratory stimulant action. Although it is unlikely that doxapram will undergo a clinical renaissance based on this new understanding, it represents a significant advance in our knowledge of the control of breathing.

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Section: Post-anesthesiamentioning

confidence: 99%

A New Look at the Respiratory Stimulant Doxapram

2006

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“…In these subjects changing the ventilatory pattern from IPPV to CPPV improved arterial oxygenation but was not associated with nitrogen release from areas where airways might have been re-opened. Another factor may be the size of tidal volumes, since treatment with a respiratory stimulant (doxapram) increases tidal volume and reduces hypoxaemia (Winnie et al, 1971;Lees et al, 1976;Pflug et al, 1976).…”

Section: Discussionmentioning

confidence: 99%

Oxygen Therapy After Thoracotomy

Drummond¹,

Milne²

1977

British Journal of Anaesthesia

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SUMMARYArterial blood samples were taken from patients before thoracotomy, and on the 1st day after operation, with the patient breathing first air, and then 24%, 28% and 35% oxygen from a venturitype mask. Pao t was reduced markedly by operation, the reduction being related to the value before operation. Oxygen therapy restored P&o t to a value greater than the value before operation in nine of 11 patients and was not associated with significant increases in Paco,. The effect of administration of oxygen on Pao, could be predicted from the Pao t when breathing air. The pattern of response to oxygen suggested that the hypoxaemia was caused by ventilation/perfusion mismatch in most of the patients.Lung function is impaired severely after thoracotomy; arterial oxygen tension is reduced, and carbon dioxide tension may be increased, particularly within hours of the operation (Maier and Cournand, 1943; Bjork and Hilty, 1954;Hood and Beall, 1958;Knudsen, 1970). Opiate analgesia may increase the respiratory acidosis (Pandit, Galway and Dundee, 1973).Patients studied on the day after thoracotomy have persistent hypoxaemia, but reduced .Pa COl! values (Hatch, 1966;Bergh et al., 1966). In this respect, they resemble patients recovering from upper abdominal surgery, whose gas exchange is impaired by ventilation/perfusion (l?y$) mismatch rather than respiratory depression. Nevertheless, it is possible that, after thoracotomy, patients remain susceptible to respiratory depression, and that this is masked by the stimulus of hypoxaemia. The influence of controlled oxygen therapy on arterial oxygen and carbon dioxide tensions in such patients has not been reported.This study was designed to assess the effects of oxygen therapy after thoracotomy. The response of Pa Oa to different oxygen fractions (Fi Oi ) might indicate the mechanism of impairment of gas transfer (Kerr, 1975; Drummond and Wright, 1977). The difference between the calculated oxygen content of blood leaving the pulmonary capillaries (Cc'o 2 ) and the oxygen content of arterial blood (Ca Oj ) can be used as an index of impaired gas transfer, in the same way as the difference between alveolar and arterial oxygen tensions (PA 02 -Pa 02 ) has been used. The advantage of the former expression is that it is not changed by changes in alveolar oxygen tension if the impaired oxygenation is caused by the shunting of a constant fraction of blood through regions where it is not exposed to gas exchange. A reduction in the value of the index during administration of oxygen shows that increasing the alveolar oxygen tension improves the efficiency of oxygen transfer, which is characteristic of impaired exchange caused by fjQ mismatch (West, 1969). This analysis depends upon the assumption that the oxygen content difference between arterial and mixed venous blood (Ca 02 -Cv 02 ) is not changed by oxygen administration.If oxygen therapy were associated with an increase in PacQj,, this would suggest that respiration had been stimulated by hypoxia when the patient was breathing ai...

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“…Doxapram hydrochloride is a respiratory stimulant which has an action both centrally and on the peripheral chemoreceptors (Kato and Buckley, 1964;Wang and Hirsch, 1973;Scott, Whitwam and Chakrabarti, 1977). The administration of doxapram has been shown to reduce respiratory complications and hypoxaemia in fit patients after abdominal surgery (Gupta and Dundee, 1974;Gawley, Dundee and Jones, 1975;Gawley et al, 1976;Downing et al, 1977).…”

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Effects of Doxapram on Postoperative Pulmonary Complications Following Thoracotomy

Sebel¹,

Kershaw²,

Rao³

1980

British Journal of Anaesthesia

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An i.v. solution of 5% dextrose with doxapram 2 mg ml-1 or 5% dextrose alone was administered to 53 patients following lateral thoracotomy. Estimations of arterial PO2, PCO2 and pH were made before operation, during infusion and 7 days after after operation. Respiratory function tests were carried out before and 7 days after operation. There were no significant differences in arterial PO2, PCO2 and pH or in respiratory function tests between those who received doxapram and those who did not. In this study doxapram did not affect the frequency of postoperative pulmonary complications.

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The Influence of Doxapram on Postoperative Pulmonary Function in Patients Undergoing Upper Abdominal Surgery

Abstract: An infusion of doxapram 250 mg in dextrose 5% compared with dextrose 5% alone in patients recovering from upper abdominal surgery was associated with a reduction in the degree of hypoxaemia after operation. This may be the result of a sparing effect on the functional residual capacity.

Cited by 13 publications

References 6 publications

A New Look at the Respiratory Stimulant Doxapram

A New Look at the Respiratory Stimulant Doxapram

Oxygen Therapy After Thoracotomy

Effects of Doxapram on Postoperative Pulmonary Complications Following Thoracotomy

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