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Review
. 2024 Mar;24(3):100-106.
doi: 10.1016/j.bjae.2023.12.007. Epub 2024 Jan 24.

Opioid-induced respiratory depression

S C Jansen  1 , A Dahan  1
Affiliations
Review

Opioid-induced respiratory depression

S C Jansen et al. BJA Educ. 2024 Mar.
No abstract available

Keywords: analgesics, opioid; pharmacology, clinical; respiration; respiratory insufficiency; respiratory physiology.

PubMed Disclaimer

Conflict of interest statement

AD has received research funding from the Dutch research Council and the US Food and Drug Administration; and consultancy fees from Trevena Inc. (USA), Takeda (Germany) and Enalare Therapeutics Inc. (USA). SCJ declares no conflicts of interest.

Figures

Fig 1
Fig 1
Effect of an opioid on the hypercapnic ventilatory response (HCVR). These curves are obtained from a single subject, and show the effects of increasing levels of end-tidal Pco2 at steady-state before and after a dose of the opioid tapentadol. The black line illustrates the HCVR curve before giving the opioid (t=0). The horizontal part of the curve illustrates resting ventilation without added CO2. Beyond the ventilatory recruitment threshold the response to added inspired CO2 shows a linear increase. This part of the curve is commonly analysed by the function Ventilation=Slope×(end-tidal Pco2–B), where B is the so-called apnoeic threshold and here shown on the x-axis by the red and black dots. The opioid has an effect on the slope of the HCVR and causes a rightward shift of the curve. The HCVR is affected more rapidly in time than baseline ventilation data. Baseline ventilation slowly drops (blue horizontal line). From Hellinga and colleagues with permission from the authors; Open access article published under the terms of the Creative Commons Attribution 4.0 International License. (http://creativecommons.org/licenses/by/4.0/).
Fig 2
Fig 2
Utility function of two opioids: oliceridine and morphine. Data are plus or minus 95% confidence interval and depict the probability of analgesia minus the probability of respiratory depression. From Dahan and colleagues, with permission.
Fig 3
Fig 3
Effect of high-affinity opioid buprenorphine on ventilatory depression induced by multiple doses of fentanyl. (A) and (B). Plasma concentrations of fentanyl and buprenorphine. (C) and (D). Fentanyl and buprenorphine mu-opioid receptor occupancy. (E) and (F). Isohypercapnic ventilation. These are simulated data, showing plasma concentrations of fentanyl and buprenorphine resulting from four consecutive doses of fentanyl (0.25, 0.35, 0.50 and 0.75 mg per 70 kg). From Olofsen and colleagues with permission of the authors; open access article published under the terms of the Creative Commons Attribution 4.0 International License. http://creativecommons.org/licenses/by/4.0/).
See this image and copyright information in PMC

References

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