Review
Neurosciences
Craig W. Stevens
Summary: This mini-review argues that current approaches to addressing opioid overdose deaths are insufficient and proposes a solution centered around targeting the opioid receptor to directly eliminate overdose deaths. By identifying key brainstem neurons controlled by opioid drugs and utilizing genetic techniques, it is possible to prevent opioid overdose. This receptor-focused solution could be implemented with existing technology and potentially undergo clinical trials within 5 to 10 years.
JOURNAL OF NEUROSCIENCE RESEARCH
(2022)
Article
Health Care Sciences & Services
Monika Salkar, Sujith Ramachandran, John P. Bentley, Ike Eriator, Gerald McGwin, Channing C. Twyner, Yi Yang
Summary: This study evaluated the relationship between opioid dose and formulation and the risk of opioid-related adverse events among Medicare-eligible older adults on long-term opioid therapy. Findings revealed that older adults receiving medically prescribed opioids at higher doses and those using long-acting and combination opioids are at increased risks for opioid-related adverse events, highlighting the importance of close patient supervision.
JOURNAL OF GENERAL INTERNAL MEDICINE
(2022)
Article
Critical Care Medicine
Amy L. Dzierba, Anas M. Khalil, Katrina L. Derry, Purnema Madahar, Jeremy R. Beitler
Summary: The study found that sedation depth is not always indicative of respiratory drive in mechanically ventilated patients. Regardless of the level of sedation, respiratory drive can vary among patients.
CRITICAL CARE MEDICINE
(2021)
Article
Multidisciplinary Sciences
Nicholas J. Malcolm, Barbara Palkovic, Daniel J. Sprague, Maggie M. Calkins, Janelle K. Lanham, Adam L. Halberstadt, Astrid G. Stucke, John D. Mccorvy
Summary: Synthetic opioids, such as nitazenes, have been proven to be potent MOR-selective superagonists, exhibiting properties distinct from conventional opioids. These drugs cause overdose and death due to their prolonged respiratory depression effects. Therefore, it is necessary to examine the pharmacological properties of these substances for future development of opioid analgesics.
Review
Toxicology
Brian A. Baldo, Michael A. Rose
Summary: Opioid-induced respiratory depression is the main cause of opioid-induced death, affected by factors such as variability in responses to opioids and individual differences. Multiple brain regions can independently exert depressive effects on breathing, including the preBotzinger complex and Kolliker-Fuse, but some signal pathways remain poorly understood. Naloxone is the main medication used to reverse opioid-induced respiratory depression.
ARCHIVES OF TOXICOLOGY
(2022)
Review
Biochemistry & Molecular Biology
Katarzyna Kaczynska, Piotr Wojciechowski
Summary: Opioids, while potent analgesics, are associated with side effects like tolerance, addiction, respiratory depression, and cardiovascular events. Researchers are seeking ways to counteract these effects, with peptides and related compounds showing potential in modulating opioid actions. Various peptides, including nociceptin/orphanin, ghrelin, oxytocin, endothelin, and venom peptides, have been researched for their modulation of opioid effects.
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
(2021)
Article
Biochemistry & Molecular Biology
Edward L. Stahl, Laura M. Bohn
Summary: A recent study suggests that low intrinsic efficacy, rather than biased agonism, is responsible for the improvement in the separation of potency in opioid-induced respiratory suppression versus antinociception. However, reanalysis of the data presented in the study supports the conclusion that biased agonism, favoring G protein signaling, was observed. The findings provide strong evidence that G protein signaling bias can improve opioid analgesia while avoiding certain undesirable side effects.
Article
Medicine, General & Internal
A. W. Thille, A. Gacouin, Remi Coudroy, Stephan Ehrmann, Jean-Pierre Frat, Mai-Anh Nay, Christophe Guitton, Damien Contou, Guylaine Labro, Jean Reignier, Gael Pradel, Gaetan Beduneau, Laurence Dangers, Clement Saccheri, Gwenael Prat, Guillaume Lacave, Nicholas Sedillot, Nicolas Terzi, Beatrice La Combe, Jean-Paul Mira, Antoine Romen, Marie-Ange Azais, Anahita Rouze, Jerome Devaquet, Agathe Delbove, Martin Dres, Jeremy Bourenne, Alexandre Lautrette, Joe de Keizer, Stephanie Ragot, Jean-Pierre Frat
Summary: For patients at high risk of extubation failure, using pressure-support ventilation (PSV) or a T-piece for spontaneous-breathing trials did not result in significantly different ventilator-free days at day 28.
NEW ENGLAND JOURNAL OF MEDICINE
(2022)
Article
Oncology
Qisen Fan, Jinhui Luo, Qianling Zhou, Yaoliang Zhang, Xin Zhang, Jiayang Li, Long Jiang, Lan Lan
Summary: Opioid-free anesthesia (OFA) provides adequate analgesia and can reduce postoperative opioid consumption in spontaneous ventilation video-assisted thoracic surgery (SV-VATS). The study shows that there is no significant difference in postoperative pain control and recovery quality between OFA group and opioid anesthesia (OA) group, but OFA group has advantages in maintaining circulatory and respiratory stability and improving the quality of pulmonary collapse during surgery.
FRONTIERS IN ONCOLOGY
(2023)
Article
Critical Care Medicine
Franka Kunovac, Ana Cicvaric, Chiara Robba, Tajana Turk, Dario Muzevic, Kristina Kralik, Slavica Kvolik
Summary: In this retrospective study, the correlation between gastrointestinal (GI) motility disorders and acute brain injury, brainstem edema, and opioid use in neurosurgical patients was investigated. The results showed that brainstem edema was associated with GI motility disorders, while opioid use had no significant impact.
NEUROCRITICAL CARE
(2023)
Article
Psychiatry
Alejandro G. Szmulewicz, Brian T. Bateman, Raisa Levin, Krista F. Huybrechts
Summary: The study found that among patients receiving prescription opioids, sedating antipsychotic agents were associated with an increased risk of overdose compared to nonsedating agents. Therefore, caution is necessary when co-prescribing these medications, and choosing a nonsedating agent whenever possible is recommended.
SCHIZOPHRENIA BULLETIN
(2022)
Article
Anesthesiology
Richard D. Urman, Ashish K. Khanna, Sergio D. Bergese, Wolfgang Buhre, Maria Wittmann, Morgan Le Guen, Frank J. Overdyk, Fabio Di Piazza, Leif Saager
Summary: This study evaluated the variation in opioid administration characteristics and its association with respiratory depression events across different regions. Despite differences in opioid administration practices between Asia, Europe, and the United States, respiratory depression remains a common issue on general care floors. Continuous monitoring and the use of post-procedure tramadol or epidural opioids may help reduce the incidence of respiratory depression in patients receiving post-operative opioids.
JOURNAL OF CLINICAL ANESTHESIA
(2021)
Article
Pharmacology & Pharmacy
Cristina M. Santana Maldonado, Dong-Suk Kim, Benton Purnell, Rui Li, Gordon F. Buchanan, Jodi Smith, Daniel R. Thedens, Phillip Gauger, Wilson K. Rumbeiha
Summary: Hydrogen sulfide (H2S) is a toxic gas that affects the cardiovascular, respiratory, and central nervous systems. This study aimed to investigate the toxic mechanisms and effects of acute H2S poisoning on the brainstem. The results showed that H2S exposure caused differential effects on brainstem neurotransmitters, induced neurodegeneration, and biochemical changes. Further research is needed to fully understand the implications of acute H2S poisoning on vital functions regulated by the brainstem.
Review
Biochemistry & Molecular Biology
Andrea Bedini, Elisabetta Cuna, Monica Baiula, Santi Spampinato
Summary: Chronic pain is a significant burden, and there is a need to develop more effective and safer analgesics. G protein-biased opioid agonists have been extensively studied as improved analgesic candidates, but the complex pharmacology of opioid receptors remains a challenge in translating them into improved therapeutics.
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
(2022)
Article
Medicine, General & Internal
Krista Stephens, Nathan Mitchell, Sean Overton, Joseph E. Tonna
Summary: This study investigated the transition from mechanical ventilation to spontaneous ventilation in ECMO patients, specifically focusing on changes in breathing patterns. The findings suggest that patients with low compliance experience increased tidal volumes, higher respiratory rates, and other significant changes during this transition. These changes in ventilatory parameters may be associated with worsened lung injury and warrant further prospective study.
JOURNAL OF CLINICAL MEDICINE
(2021)