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Titolo:
ADVERSE-EFFECTS OF OPIOID AGONISTS AND AGONIST-ANTAGONISTS IN ANESTHESIA
Autore:
BOWDLE TA;
Indirizzi:
UNIV WASHINGTON,DEPT ANAESTHESIOL,BOX 356540,ROOM RR 444 SEATTLE WA 98195
Titolo Testata:
Drug safety
fascicolo: 3, volume: 19, anno: 1998,
pagine: 173 - 189
SICI:
0114-5916(1998)19:3<173:AOOAAA>2.0.ZU;2-Z
Fonte:
ISI
Lingua:
ENG
Soggetto:
INDUCED RESPIRATORY DEPRESSION; INDUCED MUSCLE RIGIDITY; INTRAVENOUS FENTANYL INFUSIONS; BILE-DUCT PRESSURE; ANESTHETIC INDUCTION; DOUBLE-BLIND; SEROTONIN SYNDROME; PARTIAL EPILEPSY; PAIN CONTROL; MORPHINE;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
104
Recensione:
Indirizzi per estratti:
Citazione:
T.A. Bowdle, "ADVERSE-EFFECTS OF OPIOID AGONISTS AND AGONIST-ANTAGONISTS IN ANESTHESIA", Drug safety, 19(3), 1998, pp. 173-189

Abstract

The traditional view of opioids held that the individual opioid agonists shared the same mechanism of action, differing only in their potency and pharmacokinetic properties. However, recent advances in opioid receptor pharmacology have made this view obsolete. Distinguishing features of the synthetic opioid agonists are related, at least in part, to variation in affinity and intrinsic efficacy at multiple opioid receptors. Respiratory depression is the opioid adverse effect most feared by anaesthesiologists. Specific Ic-receptor agonists produce analgesia with little or no respiratory depression. There are a number of commercially available K-receptor partial agonist drugs, the so-called agonist-antagonist or nalorphine-like opioids, which appear to have a limited effect on breathing. Within the series of fentanyl analogues there are differences in behaviour towards particular opioid receptors and there is evidence for subtle differences in respiratory depressant effects. Pethidine (meperidine) causes histamine release and myocardialdepression, while the fentanyl analogues do not. Pethidine has atropine-like effects on heart rate, while fentanyl analogues reduce heart rate by a vagomimetic action. Severe bradycardia or even asystole is possible with fentanyl analogues, especially in conjunction with the vagal stimulating effects of laryngoscopy. Fentanyl analogues often produce minor reductions in blood pressure, and occasionally severe hypotension by centrally mediated reduction in systemic vascular resistance. Muscle rigidity and myoclonic movement occurs frequently during induction of anaesthesia with larger doses of opioids. Fentanyl and alfentanil have been reported to produce localised temporal lobe electrical seizure activity in patients with complex partial epilepsy. There are probably fewer biliary effects with agonist-antagonist opioids than the agonist opioids. The mechanism of adverse effects after spinal administration is distinctly different for morphine, which is very water soluble, compared with more lipid-soluble opioids. The systemic absorptionof morphine after intrathecal or epidural administration is very slow, resulting in long duration of analgesia and low plasma concentrations, while lipid-soluble opioids are rapidly absorbed into the circulation and redistributed to the brain. The serotonin syndrome may result from coadministration of pethidine, dextromethorphan, pentazocine or tramadol with monoamine oxidase inhibitors (MAOIs) or selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs). There are clinically important interactions between opioids and hypnosedatives, resulting in synergistic effects on sedation, breathing and blood pressure.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 26/01/20 alle ore 10:33:26