Components of respiratory depression after narcotic premedication in adolescents

The effects of narcotics on ventilatory control were assessed in 13 adolescents and young adults. Both a narcotic and narcotic-phenothiazine significantly depressed the CO2 response curve. Using an occlusion pressure technique (Pm100) to evaluate those neuromuscular processes that generate forces acting on the ventilatory pump, it was found that narcotic agents reduced neuromuscular drive. In most subjects, narcotics had an additional action that contributed to the overall ventilatory depression. Using carbon dioxide to vary neuromuscular drive before and after drug administration at constant levels of neuromuscular drive the drugs reduced tidal-volume responsiveness of the pump. We conclude that narcotics impair ventilation through a combination of two effects; first, reduced neuromuscular drive, most probably due to central depression, and second, increased impedance of the ventilatory pump, most probably due to a decrease in chest-wall compliance.