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BJA Advance Access originally published online on May 1, 2008
British Journal of Anaesthesia 2008 100(6):747-758; doi:10.1093/bja/aen094
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Opioids and the control of respiration

K. T. S. Pattinson*

Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK

* E-mail: kyle.pattinson{at}nda.ox.ac.uk

Respiratory depression limits the use of opioid analgesia. Although well described clinically, the specific mechanisms of opioid action on respiratory control centres in the brain have, until recently, been less well understood. This article reviews the mechanisms of opioid-induced respiratory depression, from the cellular to the systems level, to highlight gaps in our current understanding, and to suggest avenues for further research. The ultimate aim of combating opioid-induced respiratory depression would benefit patients in pain and potentially reduce deaths from opioid overdose. By integrating recent findings from animal studies with those from human volunteer and clinical studies, further avenues for investigation are proposed, which may eventually lead to safer opioid analgesia.

Keywords: analgesics opioid; brain, brainstem, respiratory control; complications, respiratory depression; receptors, chemoreceptors; ventilation, spontaneous


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