Opioid Medication and Sleep-disordered Breathing
ABSTRACT There has been a growing recognition of chronic pain that may be experienced by patients. There has been a movement toward treating these patients aggressively with pharmacologic and nonpharmacologic modalities. Opioids have been a significant component of the treatment of acute pain, with their increasing use in cases of chronic pain, albeit with some controversy. In addition to analgesia, opioids have many accompanying adverse effects, particularly with regard to stability of breathing during sleep. This article reviews the existing literature on the effects of opioids on sleep, particularly sleep-disordered breathing.
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- "Another important risk factor that is increasing in prevalence is the co-morbidity of sleep-disordered breathing in the perioperative patient (Vasu et al., 2012). Unfortunately, the majority of patients with sleep-disordered breathing remain undiagnosed and opioids and other respiratory depressants can exacerbate this condition (Yue and Guilleminault, 2010; Zutler and Holty, 2011). Furthermore, opioids may have increased potency as analgesics in pediatric and adult patients with nocturnal hypoxemia due to sleep apnea (Brown et al., 2006; Doufas et al., 2013). "
ABSTRACT: Drug-induced respiratory depression (DIRD) is a common problem encountered post-operatively and can persist for days after surgery. It is not always possible to predict the timing or severity of DIRD due to the number of contributing factors. A safe and effective respiratory stimulant could improve patient care by avoiding the use of reversal agents (e.g., naloxone, which reverses analgesia as well as respiratory depression) thereby permitting better pain management by enabling the use of higher doses of analgesics, facilitate weaning from prolonged ventilation, and ameliorate sleep-disordered breathing peri-operatively. The purpose of this review is to discuss the current pharmaceutical armamentarium of drugs (doxapram and almitrine) that are licensed for use in humans as respiratory stimulants and that could be used to reverse drug-induced respiratory depression in the post-operative period. We also discuss new chemical entities (AMPAkines and GAL-021) that have been recently evaluated in Phase 1 clinical trials and where the initial regulatory registration would be as a respiratory stimulant.Respiratory Physiology & Neurobiology 06/2013; 189(2). DOI:10.1016/j.resp.2013.06.010 · 1.97 Impact Factor
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ABSTRACT: Anaesthesiologists must be prepared to deal with pharmacokinetic and pharmacodynamic (PD) differences in morbidly obese individuals. As drug administration based on total body weight can result in overdose, weight-based dosing scalars must be considered. Conversely, administration of drugs based on ideal body weight can result in a sub-therapeutic dose. Changes in cardiac output and alterations in body composition affect the distribution of numerous anaesthetic drugs. With the exception of neuromuscular antagonists, lean body weight is the optimal dosing scalar for most drugs used in anaesthesia including opioids and anaesthetic induction agents. The increased incidence of obstructive sleep apnoea and fat deposition in the pharynx and chest wall places the morbidly obese at increased risk for adverse respiratory events secondary to anaesthetic agents, thus altering the PD properties of these drugs. Awareness of the pharmacology of the commonly used anaesthetic agents including induction agents, opioids, inhalation agents and neuromuscular blockers is necessary for safe and effective care of morbidly obese patients.BJA British Journal of Anaesthesia 12/2010; 105 Suppl 1(Suppl 1):i16-23. DOI:10.1093/bja/aeq312 · 4.35 Impact Factor
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ABSTRACT: Chronic lower back pain (CLBP) is a common problem in older adults and is a cause of significant disability in this population. Multiple treatment modalities exist for the treatment of CLBP but there is not one definitive intervention that has proven superiority over all other interventions. Spinal stenosis is a common complication of CLBP in older adults and although it is commonly diagnosed there are questions as to whether it is the principal pathology. This grand rounds presentation explores the management of chronic lower back pain in an older adult. The management strategies are presented from the perspectives of a chiropractor, a physiatrist, a geriatrician and a nurse. The management strategies presented will exemplify the varied approaches but is designed to give the clinician a broader view of the management of CLBP in older adults.