naloxone and Laryngismus

Food and Drug Administration (FDA) risk evaluation and mitigation strategies (REMs) encourage emergency responders, paramedics, law enforcement agents, and even laypeople to be trained in the administration of naloxone with the intent of rescuing individuals from a known or suspected opioid overdose.. Although naloxone is generally safe and effective at reversing respiratory depression caused by a conventional opioid such as morphine or heroin by competing with the opioid and displacing it from the μ-opioid receptor, questions increasingly are arising as to whether naloxone can adequately reverse opioid overdoses that may involve the potent opioids fentanyl and its analogues (F/FAs). In other words, as more and more opioid overdoses involve F/FAs, can naloxone keep up?. As a competitive antagonist at μ-opioid receptors, naloxone is often a life-saving agent in cases of overdose caused by conventional opioids, but it may not be versatile or powerful enough to combat the rising tide of overdoses due to fentanyl and its illicit analogues, or in cases of overdose involving combinations of opioids and non-opioids.

Topics: Diaphragm; Dose-Response Relationship, Drug; Fentanyl; Heroin; Humans; Laryngismus; Muscle Rigidity; Naloxone; Narcotic Antagonists; Opiate Overdose; Receptors, Opioid, mu; Thoracic Wall

Pulmonary edema is a generalized descriptive term for the accumulation of fluid within the interstitium and/or the alveolar spaces of the lungs. This accumulation of fluid has a cause that may be termed cardiogenic or noncardiogenic. Pulmonary edema of cardiogenic origin is usually due to failure of the left side of the heart, but it also can be attributed to the right side of the heart. Noncardiogenic pulmonary edema (NCPE) usually is attributable to certain lung injuries or disease states, but it also can be neurogenic in origin. Some occurrences of NCPE can be traced directly to the administration of anesthesia. For example, NCPE can result from upper airway obstruction or the administration of naloxone.

Topics: Airway Obstruction; Anesthesia; Capillary Permeability; Capillary Resistance; Humans; Laryngismus; Naloxone; Narcotic Antagonists; Osmotic Pressure; Pressure; Pulmonary Edema; Risk Factors

We describe a 3-year-old child who became over-sedated after receiving intranasal (IN) midazolam (0.53 mg.kg(-1)) and IN sufentanil (1 mcg.kg(-1)) for dental restorations in the dental office. Desaturation was attributed to laryngospasm, which was managed with positive pressure ventilation and oxygen. The sedation was reversed with a combination of IN flumazenil and naloxone.

Topics: Adjuvants, Anesthesia; Administration, Intranasal; Anesthesia, Dental; Antidotes; Child, Preschool; Dental Restoration, Temporary; Female; Flumazenil; Humans; Laryngismus; Midazolam; Naloxone; Narcotic Antagonists; Oxygen; Sufentanil; Treatment Outcome

To assess the occurrence of muscle rigidity after fentanyl administration in premature and term neonates.. Prospective case series, observational study.. A university hospital neonatal intensive care unit.. 8/89 preterm and term infants (25-40 wks gestational age) who received fentanyl for perioperative analgesia and sedation or intensive care procedures.. Mechanical or bag mask ventilation and antagonization with naloxone.. We observed chest wall rigidity in 8 patients after low dosage of fentanyl (3-5 microg/kg body weight). All patients presented with respiratory distress, hypercapnia, and hypoxemia leading to bradycardia. In two patients, laryngospasm was noted and associated with muscle rigidity, thus making intubation impossible. Naloxone (20-40 microg/kg body weight) reversed the laryngospasm and muscle rigidity immediately, allowing restitution within 1 min. In our patient population, we found fentanyl-induced chest wall rigidity in 4% of neonates after fentanyl administration.. Even low doses of fentanyl can lead to thoracic rigidity in neonates. Additionally, we observed laryngospasm in two patients and speculate that it might be a variant of muscle rigidity.

Topics: Fentanyl; Humans; Hypercapnia; Hypoxia; Infant, Newborn; Infant, Premature; Laryngismus; Naloxone; Narcotic Antagonists; Narcotics; Prospective Studies; Respiratory Distress Syndrome, Newborn; Thoracic Diseases

A 50-year-old woman underwent laryngoscopy. Postoperatively she received naloxone and was extubated. She developed severe laryngospasm and one hour later pulmonary edema. Both naloxone administration and laryngospasm can provoke pulmonary edema; the pathophysiology is discussed. It is suggested that naloxone is administered with care to patients who in the preceding hours have had severe laryngospasm.

Topics: Female; Humans; Laryngismus; Laryngoscopy; Middle Aged; Naloxone; Pulmonary Edema; Radiography; Respiration, Artificial

Topics: Adult; Anesthesia, General; Humans; Infant; Laryngismus; Male; Naloxone; Pulmonary Edema