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- Comparison of the efficacy of an infusion pump or standard IV push injection to deliver naloxone in treatment of opioid toxicity
- Bita Dadpour, Maryam Vahabzadeh, Babak Mostafazadeh
- Acute Crit Care. 2020;35(1):38-43. Published online February 29, 2020
- DOI: https://doi.org/10.4266/acc.2020.00010
- 7,847 View
- 176 Download
- 3 Web of Science
- 3 Crossref
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Abstract
PDF - Background
The optimal goal of naloxone infusion in intensive care units is to ameliorate opioid-induced side effects in therapy or eliminate the symptoms of opioid toxicity in overdoses. Accurately monitoring and regulating the doses is critical to prevent adverse effects related to naloxone administration. The present study aimed to compare treatment outcomes when using two methods of intravenous naloxone infusion: an infusion pump or the standard method. Methods: This study involved 80 patients with signs and symptoms of opioid overdose. The patients were randomly assigned into two groups with respect to intravenous infusion of naloxone by either an infusion pump or the standard method. Results: Comparison of study parameters between the two groups at 12 and 24 hours after intervention showed significantly more compensatory acid-base imbalance in the naloxone infusion pump group. In the group that received naloxone by pump, only one patient experienced withdrawal symptoms, but withdrawal symptoms appeared in 12 patients (30.0%) in the standard intravenous infusion group within 12 hours and in seven additional patients (17.5%) within 24 hours of intervention. In the group receiving pump-based naloxone infusion therapy, no another complications were reported; however in the standard infusion group, the 12-hour and 24-hour complication rates were 55.0% and 32.5%, respectively. The length of hospital stay was 2.85±1.05 and 4.22±0.92 days for the pump and standard infusion groups, respectively (P<0.001). Conclusions: Naloxone infusion using an infusion pump may be safer with regard to hemodynamic stability, resulting in shorter hospitalization periods, and fewer posttreatment complications. -
Citations
Citations to this article as recorded by
- Endogenous opiates and behavior: 2020
Richard J. Bodnar
Peptides.2022; 151: 170752. CrossRef - Are opioid receptor antagonists adequate for “Opioid” overdose in a changing reality?
John F. Peppin, Joseph V. Pergolizzi, Albert Dahan, Robert B. Raffa
Journal of Clinical Pharmacy and Therapeutics.2021; 46(4): 861. CrossRef - The Efficacy, Safety, and Convenience of a New Device for Flushing Intravenous Catheters (Baro Flush™): A Prospective Study
Youn I. Choi, Jae Hee Cho, Jun-Won Chung, Kyoung Oh Kim, Kwang An Kwon, Han Yong Chun, Dong Kyun Park, Yoon Jae Kim
Medicina.2020; 56(8): 393. CrossRef
- Endogenous opiates and behavior: 2020
- The Direct Myocardial Depressant Effect of Naloxone in Vitro: Mechanical and Electrophysiological Actions
- Ki Jun Kim, Haeng Cheol Lee, Ki Young Lee, Ji Young Kim, Sueng Teck Joo, Wyun Kon Park
- Korean J Crit Care Med. 2002;17(2):107-118.
- 1,657 View
- 14 Download
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Abstract
PDF
- BACKGROUND
Naloxone,an opioidant agonist, has been s hown t o have a c ar di ovascular pressor effect in states of hemorrhagic and endotoxic shock.We determined the direct inotropic effect of naloxone using guinea pig right ventricular papillary muscles.
METHODS
With institutional approval,isometric contractile force was measured in normal and 26mM K+ Tyrode's solution at various stimulation rates.Normal and slow action potentials (APs) were measured with conventional microelectrode technique.The effects of naloxone on sarcoplasmic recticulum function were evaluated by measuring rapid cooling contractures (RCCs)in normal Tyrode 's solution and rested-state (RS)contraction in low Na+ (25 mM)Tyrode's solution.Patch clamp study was performed to examine the direct effect on Ca2+ current in myocytes.
RESULTS
Naloxone (50,100,200 micro M)caused dose-dependent depression of peak force and maximal rate of peak force (dF/dt-max)by 30,50 and 70%,respectively.Modest depression was shown in RS contraction in low Na+ Tyrode's solution.In 26 mM K+ Tyrode's solution,100 micro M naloxone markedly depressed late force development.100 micro M naloxone depressed RCCs by 20%. While 100 micro M naloxone did not alter amplitude or dV/dt-max in normal and slow APs at 0.25 Hz, AP duration was prolonged significantly.In patch clamp study,50 micro M naloxone depressed Ca2+ current by 50%.
CONCLUSIONS
Naloxone depresses contractile force.Myocardial depressant effect partly seems to be caused by depressed Ca2+ influx through cardiac membrane.Rapid release of Ca2+ from the sarcoplasmic reticulum by depolarization and release by rapid cooling seems to be minimally affected.
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