484 March 2015 L EE et al.1 evaluated closed malpractice claims related to respiratory depression. They identified 92 closed claims over 20 yr in about a third of covered anesthesiologists, which corresponds very roughly to 14 closed claims per year for all anesthesiologists nationwide among perhaps 75 million cases. Three-quarters of the patients died or were left with severe brain damage; hal...

Morphine is a drug commonly administered via the epidural or intrathecal route, and is regarded by many as the 'gold-standard' single-dose neuraxial opioid due to its postoperative analgesic efficacy and prolonged duration of action. However, respiratory depression is a recognized side effect of neuraxial morphine administered in the perioperative setting. We conducted an extensive review of ar...

Opioids are respiratory depressants and heroin/opioid overdose is a major contributor to the excess mortality of heroin addicts. The individual and situational variability of respiratory depression caused by intravenous heroin is poorly understood. This study used advanced respiratory monitoring to follow the time course and severity of acute opioid-induced respiratory depression. 10 patients (...

Barbiturate use in conjunction with alcohol can result in severe respiratory depression and overdose deaths. The mechanisms underlying the additive/synergistic actions were unresolved. Current management of ethanol-barbiturate-induced apnea is limited to ventilatory and circulatory support coupled with drug elimination. Based on recent preclinical and clinical studies of opiate-induced respirat...

The effects of ten narcotic analgesics and three barbiturates have been investigated on respiratory rate, respiratory minute volume and blood Pco3 in the unanaesthetized rabbit. Both groups of drugs produced respiratory depression, and whilst the pattern of depression was similar for drugs of the same group, there were three main differences in the pattern of depression between the narcotic ana...

Respiratory depression is the major cause of death in opioid overdose. We have previously shown that prolonged treatment of mice with morphine induces profound tolerance to the respiratory-depressant effects of the drug (Hill et al., 2016). The aim of the present study was to investigate whether tolerance to opioid-induced respiratory depression is mediated by protein kinase C (PKC) and/or c-Ju...

BACKGROUND The objective of this investigation was to examine the ability of the opioid antagonist naloxone to reverse respiratory depression produced by the mu-opioid analgesic, buprenorphine, in healthy volunteers. The studies were designed in light of the claims that buprenorphine is relatively resistant to the effects of naloxone. METHODS In a first attempt, the effect of an intravenous b...

BACKGROUND Intrathecally administered morphine is effective as part of a postoperative analgesia regimen following major hepatopancreaticobiliary surgery. However, the potential for postoperative respiratory depression at the doses required for effective analgesia currently limits its clinical use. The use of a low-dose, prophylactic naloxone infusion following intrathecally administered morphi...

In summary, a patient was rapidly injected by error with morphine sulphate 60 mg epidurally. Left bundle branch block and ST segment depression signalled a problem. Respiratory depression occurred 15 minutes later. sympathetic blockade of the lower extremities was not detected. Injections of naloxone reversed the left bundle branch block, and respiratory depression but appeared to be cumulative...