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Opioids and Mechanical Ventilation

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In last years opioids have been increasingly utilized to sedate patients during mechanical ventilation. First, in Hypnotic Based Sedation (HBS), they were added to hypnotics because of their analgesic properties. Successively, in Analgesic Based Sedation (ABS), both sedative and analgesic properties were utilized and opioids were given alone; hypnotics were added only if adequate sedation was not achieved at maximum dosage. Apart from their analgesic and sedative properties, opioid effects on respiratory function are of particular value in many mechanically-ventilated patients. Dose-dependent inhibition of respiratory drive may usefully prevent spontaneous breathing during controlled ventilation, particularly when permissive hypercapnia is applied, or decrease excessive respiratory rate during assisted or noninvasive ventilation. Even cough inhibition can be valuable in some conditions, for instance, during respiratory weaning and endotracheal tube removal in patients that should not cough because of a recent tracheal resection. On the other hand, excessive respiratory depression may cause hypoventilation and apnea during assisted or spontaneous ventilation and lengthens the weaning process. In order to take advantage from positive effects and to avoid negative ones, opioid dosage should be thoroughly titrated. On this basis remifentanil has become increasingly popular as the opioid agent most suitable for ABS because of its unique, favorable pharmacokinetics.

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Keywords: Opioids; mechanical ventilation; noninvasive ventilation; respiratory function

Document Type: Research Article

Publication date: September 1, 2009

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  • Current Drug Targets aims to cover the latest and most outstanding developments on the medicinal chemistry and pharmacology of molecular drug targets e.g. disease specific proteins, receptors, enzymes, genes. Each issue of the journal will be devoted to a single timely topic, with series of in-depth reviews, written by leaders in the field, covering a range of current topics on drug targets. These issues will be organized and led by a guest editor who is a recognized expert in the overall topic. As the discovery, identification, characterisation and validation of novel human drug targets for drug discovery continues to grow; this journal will be essential reading for all pharmaceutical scientists involved in drug discovery and development.
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