Na-ATP as multimodal protector
for rapid naloxone detoxification in heroin addicts
K.M. Lebedinski, A.E. Karelov, D.A. Zakharov, O.V. Lebedinskaya
Department of Anaesthesiology and Reanimatology,
Medical Academy of Postgraduate Studies, St. Petersburg , Russia
Background and goals of the study : though rapid detoxification with naloxone (N) seems to be effective in opioid physical dependency treatment , some reports suggested caution due to N algogenic and direct vasoconstrictor activity . We tried to prevent N side effects with Na-ATP – preparation of purinergic agonist adenosine, known as systemic analgetic and potent vasodilator .
Material and methods : 45 heroin overdosage patients, aged 16–46, were admitted to the ICU with severe hypoventilation (mean PETCO2 67 ± 5 mm Hg). Under standard monitoring (ECG, NIBP, SpO 2 ) tracheal tube, cava- and urinary catheters were placed in all cases. In the first 10 patients Swan-Ganz catheter was inserted to assess PWP, CI, PVR and SVR. With institutional approval, Na-ATP infusion (25.3 ± 4.7 mkg kg–1 min–1) began 20 min before N infusion (1.4 ± 0.8 mkg kg –1 min–1, up to the total dose of 226 ± 30 mkg kg–1) and terminated 1 h after N infusion had finished. Neuromuscular block was performed with pipecuronium (mean 2.5 ± 0.8 mg kg–1 h–1, providing TOF level below 15%). CMV ventilation with nitrous oxide + oxygen 2:1 mixture during all the procedure was adjusted to reach PETCO2 32–36 mm Hg.
Results : No patient demonstrated HR, MAP, CI, PVR or SVR shifts exceeding 20% above or below the base level. PWP never exceeded 15 mm Hg, PVR poor correlated with N infusion rate (P=0.47) and significantly depended on Na-ATP infusion rate (r2 =0.45, P=0.006). Diuresis in all the patients was >1 ml kg–1 h–1. Mean time interval between detoxification completion and extubation was 65 ± 12 min, ICU bed day averaged 2.2 ± 0.5. No complication which could be contributed to N or Na-ATP administration was observed. Post-detoxification abstinent diarrhea in 32 patients was effectively controlled by loperamide (2–4 mg p.o.).
Conclusion: continuous Na-ATP infusion effectively protects heroin addicts against stress-related and hemodynamic complications during rapid naloxone detoxification procedure.
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© K.M. Lebedinski, A.E. Karelov, D.A. Zakharov, O.V. Lebedinskaya, 2006