nalbuphine and Respiratory-Insufficiency

A variety of drugs have been used to antagonize the respiratory depression caused by narcotics. Some of these drugs, such as nalorphine, naloxone, butorphanol, and nalbuphine, are opiates, which interact directly with opiate receptors. Others, such as physostigmine, doxapram, and aminophylline, probably act indirectly by stimulating neuronal pathways involved in the regulation of ventilation. None of these drugs is ideal, and all have adverse side effects. Cardiovascular instability and eradication of analgesia have been troublesome, especially with the use of naloxone. The newer mixed agonist-antagonist agents, butorphanol and nalbuphine, may have significant advantages compared with naloxone. The purpose of this review is to summarize the pharmacology of the common narcotic antagonists, with an emphasis on obtaining acceptable results while avoiding adverse side effects.

Topics: Animals; Butorphanol; Humans; Nalbuphine; Nalorphine; Naloxone; Narcotic Antagonists; Respiratory Insufficiency

To evaluate and compare the efficacy of two opioid agonist-antagonists, nalbuphine and butorphanol, in reversing etorphine-induced respiratory depression in immobilized goats.. Prospective, crossover, experimental trial conducted at 1753 m.a.s.l.. Eight adult female Boer goats (Capra hircus).. Eight minutes following immobilization with an intramuscular injection of 0.1 mg kg(-1) etorphine, goats were given one of nalbuphine (0.8 mg kg(-1) ), butorphanol (0.1 mg kg(-1) ) or sterile water intravenously, in random order in three trials. Respiratory rate (fR ), ventilation, tidal volume, oxygen consumption (V˙O2 ) and carbon dioxide production (V˙CO2 ) were measured continuously. Arterial blood samples to determine PaO2 and PaCO2 were taken 2 minutes before and at 5 minute intervals after etorphine administration for 25 minutes.. Both nalbuphine and butorphanol increased mean PaO2 from 44 mmHg (5.9 kPa) to 63 mmHg (8.4 kPa) after etorphine administration. Butorphanol, but not nalbuphine, also corrected hypopnea and hypoventilation such that fR increased from 13 ± 4 to 21 ± 7 breaths minute(-1) (compared with 16 ± 6 breaths minute(-1) following nalbuphine) and ventilation increased from 4.69 ± 3.04 to 6.91 ± 4.42 L minute(-1) following butorphanol administration. Despite decreases in PaCO2 following nalbuphine and butorphanol, PaCO2 remained elevated compared with pre-immobilization values [nalbuphine: 34 ± 3 mmHg (4.5 ± 0.3 kPa); butorphanol: 34 ± 2 mmHg (4.5 ± 0.3 kPa)] throughout the immobilization. Both agents also decreased the level of immobilization, and increased V˙O2 and V˙CO2 .. Nalbuphine and butorphanol significantly improved respiratory function in immobilized goats, with butorphanol eliciting a greater positive response than nalbuphine. However, both opioid agonist-antagonists partly reversed etorphine-induced immobilization.. Butorphanol and nalbuphine can be used to improve respiratory parameters in etorphine-immobilized wildlife, with butorphanol being more effective, but unwanted arousal can occur.

Topics: Analgesics, Opioid; Animals; Butorphanol; Cross-Over Studies; Etorphine; Female; Goats; Immobilization; Nalbuphine; Narcotic Antagonists; Prospective Studies; Respiratory Insufficiency

Dexmedetomidine has demonstrated to be useful in several clinical fields due to its respiratory safety and cardiovascular stability. We undertook this study to determine its usefulness in plastic surgery. Sixty patients were divided into two parallel groups. A group received dexmedetomidine--fentanyl and the comparison group received nalbuphine--propofol, both with same dose of midazolam. Blood pressure, heart rate and oxygen saturation were determined during the preoperative, intraoperative and recuperation periods.. In both groups, hemodynamic constants decreased intraoperatively. Dexmedetomidine--fentanyl decreased more than in the nalbuphine--propofol (systolic blood pressure, p = 0.006; diastolic blood pressure, p = 0.01 and heart rate, p = 0.007). Comparatively, oxygen saturation was greater in the dexmedetomidine--fentanyl group vs. nalbuphine--propofol (p = 0.0001). Recovery time for the nalbuphine--propofol group was shorter than in the dexmedetomidine--fentanyl group (p = 0.0001).. Dexmedetomidine shows the same cardiovascular stability but with absence of respiratory depression.

Topics: Analgesics, Opioid; Anesthetics, Intravenous; Blood Pressure; Dexmedetomidine; Drug Therapy, Combination; Fentanyl; Heart Rate; Hemodynamics; Humans; Hypnotics and Sedatives; Midazolam; Middle Aged; Nalbuphine; Oxygen; Plastic Surgery Procedures; Propofol; Respiratory Insufficiency

The new benzodiazepine antagonist flumazenil represents another approach to the ever-present problem of recurring respiratory depression after anesthesia with flunitrazepam and fentanyl. Objective and subjective side effects of flumazenil were studied in comparison with the opiate antagonists naloxone and nalbuphine. METHODS. One hundred fifty surgical patients, ASA I or II, aged 18-65 years were studied. After premedication with atropine 0.5 mg and flunitrazepam 0.5 mg anesthesia was induced with flunitrazepam 0.5 mg, fentanyl 0.1 mg and etomidate 10 mg and maintained with N2O/O2 2:1 and additional increments of 0.1 mg fentanyl as required. Relaxation for intubation and surgery was obtained with non depolarizing muscle relaxants. After the operation the patients were extubated and then flumazenil 0.4 mg, naloxone 0.05 mg, or nalbuphine 20 mg was given i.v. (randomized and double-blind). In 15 patients blood pressure and heart rate were monitored. In all patients postoperative pain was assessed by the time interval between administration of the antagonist and need for the first analgesic medication. On the 1st postoperative day recall of postoperative events and of pictures shown 5, 30, 60, 120, and 240 min after administration of the antagonist was tested. The patients were interviewed a second time for side effects on day 3-6 after the operation. RESULTS. The three antagonists produced no significant effects on arterial pressure and heart rate. There were no differences between the antagonists in the incidence of postoperative nausea and/or vomiting or postoperative pain. After flumazenil, a significant transient increase in vigilance and better recall of postoperative events was noted within 5 and 30 min after administration of the drug. CONCLUSION. On the basis of the objective clinical findings, there is no reason to prefer either benzodiazepine or opiate antagonists after flunitrazepam and fentanyl. However, postoperative amnesia can be reduced by flumazenil if this is desirable.

Topics: Adult; Double-Blind Method; Fentanyl; Flumazenil; Flunitrazepam; Humans; Middle Aged; Morphinans; Nalbuphine; Naloxone; Randomized Controlled Trials as Topic; Respiratory Insufficiency

The efficacy of nalbuphine, an agonist/antagonist opioid, in preventing respiratory depression from epidural morphine analgesia after thoracotomy, was assessed in a randomized double-blind placebo controlled trial. After a standardized general anaesthetic and 0.15 mg.kg-1 of epidural morphine, patients received a bolus and then a 24 h infusion of nalbuphine (200 micrograms.kg-1 + 50 micrograms.kg-1.hr-1, 100 micrograms.kg-1 + 25 micrograms.kg-1.hr-1, or 50 micrograms.kg-1 + 12.5 micrograms.kg-1.hr-1) or placebo. Blood gases, analgesia, sedation, side effects, and blood nalbuphine concentrations were assessed every two hours for the next 24 h. Fifty-three per cent of placebo-treated patients had a PaCO2 greater than 50 mmHg and 89 per cent of these received naloxone. A 200 micrograms.kg-1 bolus of nalbuphine followed by a 50 micrograms.kg-1.hr-1 infusion achieved a mean steady state blood level of 38.2 ng.ml-1 and prevented CO2 retention greater than 50 mmHg in all but two patients, neither of whom required naloxone. There was no difference in the incidence of side effects among groups, and analgesia appeared to be unaffected by nalbuphine.

Topics: Adult; Aged; Analgesia, Epidural; Carbon Dioxide; Double-Blind Method; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Morphinans; Morphine; Nalbuphine; Pain, Postoperative; Placebos; Respiratory Insufficiency; Thoracotomy

Postoperative pain management after scoliosis surgery is based in our institution on intrathecal morphine administration. This case report describes an immediate and major postoperative respiratory depression that occurred in the recovery room, requiring the maintenance of the endotracheal tube. This respiratory depression was reversed by i.v. administration of a low dose of nalbuphine, which allowed tracheal extubation without suppression of morphine-induced analgesia.

Topics: Adolescent; Anesthesia Recovery Period; Anesthesia, Spinal; Humans; Male; Morphine; Nalbuphine; Narcotic Antagonists; Pain, Postoperative; Respiratory Insufficiency; Scoliosis

Topics: Adolescent; Adult; Aged; Anesthesia Recovery Period; Anesthesia, General; Child; Child, Preschool; Depression, Chemical; Digestive System Diseases; Fentanyl; Heart Diseases; Humans; Middle Aged; Nalbuphine; Naloxone; Postoperative Care; Respiratory Insufficiency; Wounds and Injuries

A large number of opioids and nonopioids have been administered epidurally and intrathecally in the hope of providing segmental analgesia without serious adverse effects. However, neurotoxicity data are generally unavailable for many of these drugs. The present study evaluated the behavioral, motor, electroencephalographic, and histopathologic changes following intrathecal injection of large and small doses of butorphanol, sufentanil, and nalbuphine in sheep. Thirty-two sheep (20-32 kg) were anesthetized and catheters placed intrathecally after hemilaminectomy. The large doses of butorphanol, sufentanil and nalbuphine were 0.375 mg/kg (4.4-5.2 ml), 7.5 micrograms/kg (3.6-4.8 ml) and 0.75 mg/kg (1.5-2.4 ml), and the small doses were 0.075 mg/kg (0.9-1.1 ml), 1.5 micrograms/kg (0.7-0.9 ml) and 0.15 mg/kg (0.38-0.5 ml), respectively. The opioids were administered intrathecally every 6 h for 3 days and the above-mentioned parameters studied. Five sheep received intrathecal saline (1.1 or 5.2 ml) and served as controls. Histopathologic changes were evaluated by a neuropathologist blinded to the study protocol. Irrespective of dose, intrathecal injection of butorphanol was associated with severe behavioral responses such as agitation, rigidity, vocalization, and restlessness, as well as prolonged or irreversible hindlimb paralysis. Electroencephalography showed increased cortical activity or seizure activity. One sheep died because of severe respiratory depression that did not respond to naloxone. Spinal cord histologic changes consisted of suppurative meningitis and myelitis as well as neuronal changes such as spongiosis and chromatolysis. Large doses of intrathecal sufentanil were associated with similar though somewhat less severe responses. The behavioral and motor changes following the small dose of intrathecal sufentanil were of mild to moderate nature. Following intrathecal nalbuphine, the above-mentioned changes were similar to those seen in control animals. We conclude that butorphanol in doses of 0.075 and 0.375 mg/kg intrathecally and sufentanil 7.5 micrograms/kg intrathecally are neurotoxic in sheep.

Topics: Animals; Butorphanol; Dose-Response Relationship, Drug; Electroencephalography; Fentanyl; Injections, Epidural; Injections, Spinal; Motor Activity; Nalbuphine; Respiration; Respiratory Insufficiency; Sheep; Spinal Cord; Sufentanil

Topics: Adult; Female; Humans; Labor, Obstetric; Nalbuphine; Pregnancy; Respiratory Insufficiency

Topics: Analgesia, Epidural; Analgesics; Fentanyl; Humans; Morphinans; Morphine; Nalbuphine; Respiratory Insufficiency; Sufentanil

The use of epidural opioids for postoperative analgesia has been associated with respiratory depression. This report demonstrates the ability of nalbuphine to rapidly reverse the respiratory depression caused by epidural sufentanil while maintaining postoperative pain relief.

Topics: Aged; Female; Fentanyl; Humans; Injections, Epidural; Morphinans; Nalbuphine; Respiratory Insufficiency; Sufentanil

Examination of haemodynamic changes, after 20 mg nalbuphine had been administered IV to 11 ventilated patients with acute respiratory failure, showed that on average pulmonary arterial mean pressure increased by 8% of the initial value. This increase was reversed after the test dosage was doubled from 20 mg to 40 mg nalbuphine. Regression analysis of the correlation between changes in pulmonary arterial mean pressure and patient age resulted in an increase in mean pressure by 0.1 mmHg per year after 20 mg nalbuphine. These findings suggest that nalbuphine must be carefully monitored in elderly and pulmonary risk patients.

Topics: Adolescent; Adult; Aged; Hemodynamics; Humans; Male; Middle Aged; Morphinans; Nalbuphine; Respiration, Artificial; Respiratory Insufficiency

Topics: Humans; Morphinans; Nalbuphine; Postoperative Complications; Respiratory Insufficiency; Time Factors

Topics: Adult; Aged; Female; Humans; Male; Morphinans; Nalbuphine; Postoperative Complications; Respiratory Insufficiency; Time Factors

Topics: Aged; Female; Heroin; Humans; Morphinans; Nalbuphine; Postoperative Complications; Respiratory Insufficiency; Time Factors