naloxone and Cyanosis

Carfentanil is a synthetic opioid with an estimated potency that is 10,000 times more than that of morphine and 100 times more than that of fentanyl. Although there is a paucity of evidence, when considering the potency of carfentanil, it is reasonable to speculate that larger doses of naloxone may be required to resuscitate patients after carfentanil ingestion. This case report discusses the use of high-dose naloxone in 2 patients with suspected carfentanil overdose presenting to a small community hospital.. Two patients with suspected carfentanil overdose presented to a 30-bed emergency department at a community hospital in New Hampshire. Cyanosis and respiratory distress were noted in both instances, and airway intervention was ultimately deemed necessary. Patient 1 required a total of 12 mg of naloxone to be successfully resuscitated, while patient 2 required a total of 10 mg for resuscitation. Both patients were successfully resuscitated with high doses of naloxone. The use of high-dose naloxone prevented the need for intubation in these patients.. While more robust studies should be considered, emergency personnel should be comfortable using higher-than-standard doses of naloxone in appropriate cases.

Topics: Adult; Analgesics, Opioid; Cardiopulmonary Resuscitation; Cyanosis; Drug Overdose; Female; Fentanyl; Hospitals, Community; Humans; Male; Naloxone; Narcotic Antagonists; Opioid-Related Disorders; Schizophrenia; Substance-Related Disorders

We report a case of a female neonate who developed respiratory depression following the unintentional administration of methylergonovine. The respiratory depression appeared to improve after the administration of bag mask ventilation, stimulation, and naloxone; and the baby was able to be managed without endotracheal intubation and prolonged positive-pressure ventilation.. A full-term female neonate was delivered vaginally without issue. Approximately 10 min after delivery, the infant was inadvertently administered 0.1 mg of methylergonovine intramuscularly instead of vitamin K. Thirty minutes later the child developed cyanotic extremities and respiratory depression with an oxygen saturation of 75%. Naloxone, 0.4 mg IM, was recommended to mitigate respiratory depression. Within 5 min the patient's respirations improved to 40 breaths per minute, cyanosis improved, and she began resisting ventilations and crying loudly. The child continued to improve and was back to baseline that evening.. Methylergonovine toxicity in neonates has been commonly associated with respiratory depression necessitating ventilatory support. In consideration of chemical structural similarity between methylergonovine and morphine, as well as signs/symptoms consistent with opioid-induced respiratory depression, naloxone was suggested.. It appears that naloxone may reverse methylergonovine toxicity in neonates. The identification of a safe and potentially useful antidote to mitigate respiratory depression, potentially avoiding the need for intubation and more invasive interventions in this patient population is important.

Topics: Combined Modality Therapy; Cyanosis; Female; Humans; Infant, Newborn; Injections, Intramuscular; Medication Errors; Methylergonovine; Naloxone; Narcotic Antagonists; Oxytocics; Respiratory Insufficiency; Treatment Outcome

Naloxone, a specific opiate antagonist, is widely used during neonatal resuscitation to reverse possible opiate-induced respiratory depression.. To determine the frequency with which naloxone is administered when resuscitation guidelines are conscientiously followed and to document any effect on respiratory morbidity.. Perinatal data including naloxone administration and respiratory morbidity were collected retrospectively, and compared with prospectively collected data following the introduction of "Good Practice" guidelines.. There were 500 deliveries in the retrospective arm of the study and 1000 deliveries in the prospective arm. Although a similar proportion of women received opiates in labour in the two periods of study, there was a marked reduction in the use of naloxone when the guidelines were introduced (11% of opiate-exposed deliveries compared to 0.2%). There was no significant effect on respiratory morbidity with the change in practice.. Naloxone is rarely needed to reverse the effects of opiates in newborn infants, and its use can be curtailed by following current resuscitation guidelines without increasing respiratory morbidity.

Topics: Cyanosis; Guideline Adherence; Humans; Infant, Newborn; Naloxone; Narcotic Antagonists; Practice Guidelines as Topic; Respiratory Insufficiency

The Neonatal Resuscitation Programme, sponsored by the Canadian Heart and Stroke Foundation and by the American Heart Association, is a structured learning package and workshop for all individuals who provide resuscitation for newborns. The emphasis is on rapid, decisive action using algorithms based on clearly stated criteria. This CME article serves as an introduction to the NRP and discusses some of the new guidelines regarding concurrent ventilation and chest compressions, tracheal suction for meconium and the use of medications. The author encourages readers who find this article helpful to register in an accredited NRP course to receive the extensive illustrated textbook and to benefit from the "hands-on" nature of the workshop.

Topics: Asphyxia Neonatorum; Body Temperature; Cyanosis; Education, Medical, Continuing; Epinephrine; Heart Rate; Humans; Infant, Newborn; Intubation, Intratracheal; Laryngoscopy; Masks; Meconium; Naloxone; Plasma Substitutes; Positive-Pressure Respiration; Practice Guidelines as Topic; Respiration; Respiration, Artificial; Resuscitation; Suction