Two Cases of Naloxone-Induced Pulmonary Oedema — The Possible Use of Phentolamine in Management

Morphine-induced acute lung injury

“…Although the summary of product characteristics for morphine points out that "noncardiogenic pulmonary edema has been observed in intensive-care patients," very few reports about this issue can be found in the scientific literature [1,2]. In addition to opioid-induced acute lung injury (ALI), there are a number of publications on the occurrence of pulmonary edema after heroin intoxication and administration of naloxone and buprenorphine [3][4][5][6][7][8][9][10][11]. The exact mechanisms of these effects are not yet fully understood; opioid-induced ALI occurring approximately two to 4 hours after drug intake is characterized by dyspnea, significant hypoxia, and bilateral infiltrates [12].…”

Naloxone in opioid poisoning: walking the tightrope

“…Pulmonary oedema has been reported but most instances have occurred in the postoperative period [33][34][35][36][37][38][39] or in the presence of pre-existing cardiorespiratory disease, 40 and in many of these reports it can be difficult to differentiate between the effect of naloxone and the effect of the underlying disease process or other drugs that have been ingested or administered. Many episodes of pulmonary oedema secondary to opioid toxicity have been published since it was first noted by William Osler in the 1880s 5 41-50 and it has been suggested that naloxone simply reveals the opioid induced pulmonary oedema that had been masked by the respiratory depression.…”

High-Alert Medications in the Perioperative Setting

“…At our institution, for example, neuromuscular blocking drugs (1) are stocked in a very limited number of areas, (2) are stored separately in the pharmacy, (3) are provided in standardized concentrations and product formulations with warning labels on the vials, (4) have additional drug preparation verification, and (5) require continual close monitoring.…”

“…In postoperative patients, the administration of naloxone can cause hypertension, ventricular dysrhythmias, pulmonary edema, and cardiac arrest. 2,3 To reverse clinically significant respiratory depression, dilute the naloxone and administer it slowly. Monitor the patient's response and titrate to the desired effect.…”