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Opioid-induced respiratory depression is associated with increased tidal volume variability
T Bouillon1, J Bruhn, H Roepcke
1University of Bonn, Department of Anaesthesia and Critical Care Medicine, Bonn, Germany. tbouillon1@hotmail.com
European Journal of Anaesthesiology
|March 8, 2003
Summary
Opioid infusions significantly increase breathing irregularity, measured by Qeff20V(T), and decrease minute ventilation. This increased irregularity can predict the severity of opioid-induced respiratory depression.
Area of Science:
- Anesthesiology
- Pharmacology
- Respiratory Physiology
Background:
- Mu-agonistic opioids are known to cause hypoventilation and irregular breathing patterns.
- Understanding the time-course and predictive value of this irregularity is crucial for patient safety.
Purpose of the Study:
- To quantify opioid-induced breathing irregularity.
- To investigate the time-course of this irregularity during and after opioid infusion.
- To assess the ability of breathing irregularity to predict respiratory depression severity.
Main Methods:
- Twenty-three spontaneously breathing patients received intravenous infusions of alfentanil or piritramide.
- Minute ventilation and tidal volumes were measured using an anesthesia workstation.
- Breathing regularity was quantified using the quartile coefficient of tidal volume (Qeff20V(T)) for every 20 breaths.
Main Results:
- Both minute ventilation decrease and Qeff20V(T) increase were highly significant during and after opioid infusion (P < 0.001).
- Patients with prematurely terminated infusions had lower minute volumes and higher Qeff20V(T).
- Changes in breathing regularity (Qeff20V(T)) paralleled changes in minute ventilation.
Conclusions:
- Opioids induce a complex disruption of respiratory control beyond simple PCO2 changes.
- The quartile coefficient of tidal volume (Qeff20V(T)) effectively predicts the severity of opioid-induced respiratory depression.