naloxone and Obesity--Morbid

Noninvasive positive pressure ventilation (NIPPV) may improve postoperative lung function and reduce postoperative complications in patients undergoing abdominal surgery. The purpose of our study was to determine whether the timing of postoperative NIPPV affects lung function 1 day postoperatively.. Forty morbidly obese patients with known obstructive sleep apnea undergoing laparoscopic bariatric surgery with standardized anesthesia care were randomly assigned to receive NIPPV immediately after tracheal extubation (immediate group) or supplemental oxygen (standard group). All patients had continuous positive airway pressure initiated 30 minutes after extubation in the postanesthesia care unit (PACU) via identical noninvasive ventilators. Spirometry was performed by a blinded observer in the perioperative holding area 1 hour after admission to the PACU and 1 day postoperatively. The primary outcome was the change in forced vital capacity (FVC) from baseline to 24 hours (FVC baseline-FVC 24 hours).. Forty patients, 20 in each group, were enrolled in the study. Forced expiratory volume in 1 second, FVC, and peak expiratory flow rate were significantly reduced in both groups from perioperative values throughout the study. At 24 hours, the intervention group had lost only 0.7 L FVC, versus 1.3 L for the intervention group (P = 0.0005). An analysis of covariance confirmed this and indicated that the immediate postoperative NIPPV better preserved spirometric function at 1 and 24 hours postoperatively. Specifically, the differences in the primary outcome were statistically significant.. NIPPV given immediately after extubation significantly improves spirometric lung function at 1 hour and 1 day postoperatively, compared with continuous positive airway pressure started in the PACU, in morbidly obese patients with obstructive sleep apnea undergoing laparoscopic bariatric surgery.

Topics: Adult; Anesthesia, Inhalation; Bariatric Surgery; Critical Care; Female; Heart Arrest; Humans; Intubation, Intratracheal; Laparoscopy; Lung; Male; Middle Aged; Naloxone; Narcotic Antagonists; Obesity, Morbid; Oximetry; Oxygen; Peak Expiratory Flow Rate; Positive-Pressure Respiration; Respiration, Artificial; Respiratory Insufficiency; Sleep Apnea, Obstructive; Spirometry; Treatment Outcome; Vital Capacity

Methadone is a well-established maintenance drug for the therapy of opioid addicts. Reduction of mortality, social stabilization and reintegration are basic goals of this therapeutic concept. In the ideal case, total opioid abstinence can be achieved. In Germany, detailed guidelines exist for methadone maintenance treatment (e. g. choice of the maintenance drug, "take home" doses) and are regularly published and updated by the National Medical Council. In the social environment of opioid addicts, misuse or accidental intoxication in non-addict family members or co-addicts may occur. We report an intoxication with methadone of the husband of a heroin-addict patient. In this morbidly obese patient, a simultaneous ingestion of benzodiazepines was suspected. This case report describes the diagnostic and therapeutical options of an opioid intoxication in a patient with severe obesity with special emphasis on the airway management strategy in an out-of-hospital situation.

Topics: Analgesics, Opioid; Anti-Anxiety Agents; Benzodiazepines; Blood Gas Analysis; Diazepam; Emergency Medical Services; Heroin Dependence; Humans; Male; Methadone; Middle Aged; Naloxone; Narcotic Antagonists; Obesity, Morbid; Social Environment

To determine whether altered central and/or peripheral opioidergic mechanisms contribute to the altered ventilatory response to sustained hypoxia in obese Zucker rats.. Eight lean (176 +/- 8 [SEM] g) and eight obese (225 +/- 12 g) Zucker rats were studied at 6 weeks of age. Pulmonary ventilation ((E)), tidal volume (V(T)), and breathing frequency (f) at rest and in response to sustained (30 minutes) hypoxic (10% O(2)) challenges were measured on three separate occasions by the barometric method after the randomized, blinded administration of equal volumes of saline (control), naloxone methiodide (N(M); 5 mg/kg, peripheral opioid antagonist), or naloxone hydrochloride (N(HCl); 5 mg/kg, peripheral and central opioid antagonist).. Administration of N(M) and N(HCl) in lean animals had no effect on (E) either at rest or during 30 minutes of sustained exposure to hypoxia. Similarly, N(M) failed to alter (E) in obese rats. In contrast, N(HCl) significantly (p < 0.05) increased (E) and V(T) both at rest and during 2 to 10 minutes of hypoxic exposure in obese rats. After 20 to 30 minutes of hypoxic exposure, V(T) remained elevated with N(HCl), but the earlier elevation of (E) seemed to be attenuated due to a decrease in f at 20 minutes of exposure to hypoxia.. Thus, endogenous opioids modulate both resting (E) and the ventilatory response to sustained hypoxia in obese, but not in lean, Zucker rats by acting specifically on opioid receptors located within the central nervous system.

Topics: Animals; Carbon Dioxide; Hypoxia; Kinetics; Male; Naloxone; Narcotic Antagonists; Obesity, Morbid; Opioid Peptides; Oxygen; Pulmonary Gas Exchange; Pulmonary Ventilation; Quaternary Ammonium Compounds; Random Allocation; Rats; Rats, Zucker

Levels of endogenous opioids are increased in morbidly obese humans and obese rats. Endogenous opioids are important neuromodulators, and are involved in a wide range of functions including ventilatory control. We studied eight lean and eight obese Zucker (Z) rats at 6 and 16 wk of age. We assessed minute ventilation (V E) at rest and during hypercapnic challenges, as well as peak oxygen consumption (V O(2peak)) after the administration of saline (control), naloxone hydrochloride (N(HCl)), and naloxone methiodide (N(M)). Administration of N(HCl) and N(M) to lean animals had no effect on V E and V O(2peak). Similarly, N(M) failed to alter V E and V O(2peak) in obese rats studied at 6 or 16 wk of age. In young obese rats, N(HCl) significantly (p < 0.05) increased resting V E (721 +/- 154 [mean +/- SD] ml/kg/min versus 937 +/- 207 ml/kg/min, saline versus N(HCl), respectively); VE in response to 4% CO(2) (924 +/- 110 ml/kg/min versus 1,212 +/- 172 ml/ kg/min); V E in response to 8% CO(2) (1,233 +/- 172 ml/kg/min versus 1,565 +/- 327 ml/kg/min); and V O(2peak) (90.8 +/- 9.6 ml/kg(0.75)/min versus 98.3 +/- 5.9 ml/kg(0.75)/min). However, N(HCl) administration had no effect on V E or V O(2peak) in obese rats retested at 16 wk of age. Thus, endogenous opioids modulate resting ventilation, ventilatory responsiveness to CO(2), and V O(2peak) in young obese rats by acting specifically on receptors located within the central nervous system. This modulation disappears once the animals reach 16 wk of age.

Topics: Animals; Carbon Dioxide; Male; Naloxone; Narcotic Antagonists; Obesity, Morbid; Opioid Peptides; Oxygen; Pulmonary Gas Exchange; Quaternary Ammonium Compounds; Rats; Rats, Zucker