Is there a higher risk of respiratory depression in opioid-naïve palliative care patients during symptomatic therapy of dyspnea with strong opioids?

Is there a higher risk of respiratory depression in opioid-naïve palliative care patients during symptomatic therapy of dyspnea with strong opioids?

MedLine Citation:	PMID: 18333735 Owner: NLM Status: MEDLINE
Abstract/OtherAbstract:	OBJECTIVE: Dyspnea is a highly prevalent symptom in palliative care patients. Opioids are the first-line therapy for symptomatic relief of dyspnea. However, respiratory depression is still a feared side effect of therapy with WHO III opioids. The risk of respiratory depression in opioid-naïve patients and in patients pretreated with strong opioids during symptomatic therapy of dyspnea was investigated in palliative care patients. PATIENTS AND METHODS: Twenty-seven patients were included in a prospective, nonrandomized study. All patients suffered from moderate to severe dyspnea. Transcutaneous measurement (earlobe sensor) of carbon dioxide partial pressure (tcpaCO(2)), pulse oximetry oxygen saturation (SaO(2)), and pulse frequency (PF) were monitored with SenTec Digital Monitor (SenTec AG, Therwill, CH). The following monitoring data were compared: baseline recording for 15 minutes, and 30, 60, 90, and 120 minutes after opioid application. RESULTS: The data obtained with transcutaneous measurement showed that there were no significant differences between the groups of opioid-naïve patients and those pretreated with strong opioids with regard to tcpaCO(2) increase or SaO(2) decrease after the first opioid application. Neither SaO(2) decreased significantly nor tcpaCO(2) increased significantly after the initial opioid application, which means there was no opioid-induced respiratory depression. The first opioid application, however, resulted in a significant decrease in the intensity of dyspnea and respiratory rate. CONCLUSIONS: No higher risk of respiratory depression and increase in tcpaCO2 in opioid-naïve palliative care patients, compared to patients pretreated with strong opioids, during symptomatic therapy of dyspnea with strong opioids could be found.

Authors:	Katri Elina Clemens; Ines Quednau; Eberhard Klaschik
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Publication Detail:	Type: Journal Article; Research Support, Non-U.S. Gov't
Journal Detail:	Title: Journal of palliative medicine Volume: 11 ISSN: 1096-6218 ISO Abbreviation: J Palliat Med Publication Date: 2008 Mar
Date Detail:	Created Date: 2008-03-12 Completed Date: 2008-07-02 Revised Date: 2008-11-07
Medline Journal Info:	Nlm Unique ID: 9808462 Medline TA: J Palliat Med Country: United States
Other Details:	Languages: eng Pagination: 204-16 Citation Subset: IM
Affiliation:	Department of Science and Research for Palliative Medicine, University of Bonn, Bonn, Germany. katrina-elina.clemens@malteser.de
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MeSH Terms
Descriptor/Qualifier:	Adult Aged Aged, 80 and over Analgesics, Opioid / adverse effects* Carbon Dioxide / metabolism Drug Therapy / statistics & numerical data* Dyspnea / drug therapy, epidemiology, metabolism Female Humans Male Middle Aged Narcotics / adverse effects Neoplasms / epidemiology Oximetry Oxygen / metabolism Palliative Care / statistics & numerical data* Prevalence Prospective Studies Respiratory Insufficiency / chemically induced, epidemiology, metabolism Risk Factors
Chemical
Reg. No./Substance:	0/Analgesics, Opioid; 0/Narcotics; 124-38-9/Carbon Dioxide; 7782-44-7/Oxygen
Comments/Corrections
Comment In:	J Palliat Med. 2008 Jul;11(6):822 [PMID: 18715170 ]

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