BACKGROUND This study examines the evidence from published data concerning the adverse respiratory and haemodynamic effects of three analgesic techniques after major surgery; i.m. analgesia, patient-controlled analgesia (PCA), and epidural analgesia. METHODS A MEDLINE search of the literature was conducted for publications concerned with the management of postoperative pain. Information relat...

Mutant mice lacking NMDA receptor 1 subunit (NR1) showed marked depression of respiratory and suckling activities in vivo and overexpression of synaptic long-term depression (LTD) in a brainstem cardiorespiratory-related region (nucleus tractus solitarius) in vitro. Pharmacological blockade of NMDA receptors in normal newborn mice mimicked the depression in suckling activity but not respiratory...

Neuraxial opioids have contributed significantly to improved labor and postcesarean delivery analgesia. In the obstetric population, epidural and intrathecal opioids are associated with a very low risk of clinically significant respiratory depression. Although rare, respiratory depression is a serious risk; patients may die or suffer permanent brain damage as a consequence. This review discusse...

A case of respiratory depression which occurred following administration of epidural meperidine during Caesarean section is described. Epidural meperidine, 75 mg (10 mg.ml-1) was given after delivery of the infant to provide postoperative analgesia. Oxygen desaturation (SaO2 90%) and a decrease in respiratory rate (4.min-1) were noted 30 min after epidural meperidine was administered. Naloxone,...

Opioids activate glia in the central nervous system in part by activating the toll-like receptor 4 (TLR4)/myeloid differentiation 2 (MD2) complex. TLR4/MD2-mediated activation of glia by opioids compromises their analgesic actions. Glial activation is also hypothesized as pivotal in opioid-mediated reward and tolerance and as a contributor to opioid-mediated respiratory depression. We tested th...

Several studies demonstrate that, within the ventral medullary surface (VMS), excitatory amino acids are necessary components of the neural circuits involved in the tonic and reflex control of respiration and circulation. In the present study we investigated the cardiorespiratory effects of unilateral microinjections of the broad spectrum glutamate antagonist kynurenic acid (2 nmol/200 nl) alon...

To the Editor: With regard to the letter on the abovementioned subject by Cajee and Buchanan,' I' should like to make the following comments: While the articles by Adams and Pybus' and Becker et al.' are valuable and raise doubts about fentanyl's being a 'shortacting' drug, perhaps the most telling evidence against these doubts is contained in an article by Morgan et al." which reported a study...

Opioids evoke respiratory depression, bradycardia, and reduced respiratory sinus arrhythmia, whereas serotonin (5-HT) agonists stimulate respiration and cardiorespiratory interactions. This study tested whether serotonin agonists can prevent the inhibitory effects of opioids on cardiorespiratory function. Spontaneous and rhythmic inspiratory-related activity and gamma-aminobutyric acid (GABA) n...