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British Journal of Anaesthesia, 1988, Vol. 61, No. 3 318-323
© 1988 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

ANTAGONISM OF MORPHINE-INDUCED RESPIRATORY DEPRESSION WITH NALMEFENE

K. M. KONIECZKO, F.F.A.R.C.S., J. G. JONES, M.D., F.R.C.P., M. P. BARROWCLIFFE, F.F.A.R.C.S., C. JORDAN, B. TECH and D. G. ALTMAN, B.SC., M.R.C.

M.R.C. Division of Anaesthesia Northwick Park Hospital, Harrow, Middx
Department of Anaesthesia, University of Leeds 24 Hyde Terrace, Leeds LS2 9LN
Section of Medical Statistics Northwick Park Hospital, Harrow, Middx

The duration of respiratory depression induced by morphine 10 mg/70 kg was studied following the administration of one of two opioid antagonists. Respiratory measurements included: (i) the ventilatory response to carbon dioxide, described in two ways—the minute ventilation at an end-tidal carbon dioxide partial pressure of 8 kPa (VE8) and the log slope of the ventilatory response to carbon dioxide; (ii) resting end-tidal carbon dioxide partial pressure; (iii) rate of ventilation. One hour after administration of morphine, one of the following was given i.v.: nalmefene 0.4 mg/70 kg; naloxone 0.4 mg/ 70 kg (low dose): naloxone 1.6 mg/ 70 kg (high dose); or saline placebo. The depression of VE8 by morphine was antagonized by all three treatments for the 1.5 h after the injection. However, for the 1.5–6 h after antagonist, VE8 following naloxone became depressed, whereas VE8 after nalmefene remained significantly increased compared with other treatments. Nalmefene restored the slope of the ventilatory response to baseline for 6 h and differed significantly from low but not high dose naloxone. Resting end-tidal carbon dioxide measurements demonstrated that nalmefene activity exceeded that of low but not high dose naloxone over the 1.5–4.5 h period. Rate of ventilation was not different between treatments.


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