Quantified Changes in End-tidal Carbon Dioxide During Procedural Sedation Are Associated with Specific Clinical Signs of Respiratory Depression

2007 ◽  
Vol 14 (5 Supplement 1) ◽  
pp. S194-S194
Author(s):  
J. Mayerle ◽  
D. Hubbard ◽  
J. Miner
Keyword(s):  
Carbon Dioxide ◽  
Respiratory Depression ◽  
Clinical Signs ◽  
Procedural Sedation ◽  
End Tidal Carbon Dioxide ◽  
End Tidal

scholarly journals Differential Effect of Morphine and Morphine-6-glucuronide on the Control of Breathing in the Anesthetized Cat

2008 ◽  
Vol 109 (4) ◽  
pp. 689-697 ◽  
Author(s):  
Luc J. Teppema ◽  
Eveline van Dorp ◽  
Babak Mousavi Gourabi ◽  
Jack W. van Kleef ◽  
Albert Dahan
Keyword(s):  
Carbon Dioxide ◽  
Respiratory Depression ◽  
Carbon Dioxide Concentration ◽  
Compartment Model ◽  
Central Component ◽  
Depressant Effect ◽  
End Tidal Carbon Dioxide ◽  
Mu Opioids ◽  
End Tidal ◽  
Anesthetized Cat

Background Morphine's metabolite, morphine-6-glucuronide (M6G), activates the mu-opioid receptor. Previous data suggest that M6G activates a unique M6G receptor that is selectively antagonized by 3-methoxynaltrexome (3mNTX). The authors compared the effects of M6G and morphine on breathing in the anesthetized cat and assessed whether 3mNTX reversal was selective for M6G. Methods Step changes in end-tidal carbon dioxide concentration were applied in cats anesthetized with alpha-chloralose-urethane. In study 1, the effect of the 0.15 mg/kg morphine followed by 0.2 mg/kg 3mNTX and next 0.8 mg/kg M6G was assessed in six cats. In study 2, the effect of 0.8 mg/kg M6G followed by 0.2 mg/kg 3mNTX and 0.15 mg/kg morphine was tested in another six cats. The ventilatory carbon dioxide responses were analyzed with a two-compartment model of the ventilatory controller, which consists of a fast peripheral and a slow central component. Results Both opioids shifted the ventilatory carbon dioxide responses to higher end-tidal carbon dioxide levels. Morphine had a preferential depressant effect within the central chemoreflex loop. In contrast, M6G had a preferential depressant effect within the peripheral chemoreflex loop. Irrespective of the opioid, 3mNTX caused full reversal of and prevented respiratory depression. Conclusions In anesthetized cats, the mu-opioids morphine and M6G induce respiratory depression at different sites within the ventilatory control system. Because 3mNTX caused full reversal of the respiratory depressant effects of both opioids, it is unlikely that a 3mNTX-sensitive unique M6G receptor is the cause of the differential respiratory behavior of morphine and M6G.

scholarly journals Squamous Papilloma Causing Airway Obstruction During Conscious Sedation

2017 ◽  
Vol 64 (3) ◽  
pp. 168-170
Author(s):  
Paul Brady ◽  
Christine McCreary ◽  
Ken D. O'Halloran ◽  
Catherine Gallagher
Keyword(s):  
Carbon Dioxide ◽  
Oxygen Saturation ◽  
Airway Obstruction ◽  
Respiratory Rate ◽  
Respiratory Depression ◽  
Conscious Sedation ◽  
Monitoring Tool ◽  
Squamous Papilloma ◽  
End Tidal Carbon Dioxide ◽  
End Tidal

Monitoring for respiratory depression is essential during conscious sedation. We report a case of a squamous papilloma as an unusual cause of intermittent partial airway obstruction in a 43-year-old man undergoing intravenous conscious sedation with midazolam. The Integrated Pulmonary Index (IPI) is an algorithm included in some commercially available monitors that constitutes a representation of 4 parameters: end-tidal carbon dioxide, respiratory rate, oxygen saturation, and pulse rate. We discuss the potential of the IPI as a monitoring tool during sedation.

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