Central and respiratory depression
Opioid induced respiratory depression
Please note that the use and doses of these agents in anaesthesia are different from those given for the treatment of poisoning/overdose.
Naloxone
Naloxone 400micrograms/1ml solution for injection ampoules
Refer to BNF for dose information.
Prescribing Notes:
- The antagonist should be matched to the cause of the respiratory depression. All doses should be titrated to the patient’s response.
- Since the duration of action of naloxone may be less than the duration of the opioid causing respiratory depression, repeat doses may be required. Naloxone also antagonises the analgesic effects of opioids.
- For treatment of opioid overdose, see Opioid dependence condition page.
History Notes
27/10/2022
East Region Formulary content agreed.
Reversal of benzodiazepine-induced respiratory depression
Please note that the use and doses of these agents in anaesthesia are different from those given for the treatment of poisoning/overdose.
Flumazenil
Flumazenil 500micrograms/5ml solution for injection ampoules
Refer to BNF for dose information.
Prescribing Notes:
- The antagonist should be matched to the cause of the respiratory depression. All doses should be titrated to the patient’s response.
- For treatment of opioid overdose, see Opioid dependence condition page.
- Flumazenil is potentially hazardous in patients receiving central nervous system drugs and may precipitate withdrawal symptoms in patients who are benzodiazepine dependent.
History Notes
27/10/2022
East Region Formulary content agreed.
Malignant hyperthermia due to anaesthesia
Dantrolene
Dantrolene 20mg powder for solution for injection vials
By rapid intravenous injection. Initially 2-3 mg/kg, then 1 mg/kg, repeated if necessary; maximum 10 mg/kg per course.
Prescribing Notes:
- Advice regarding the treatment of hyperthermia induced by other drugs, such as MDMA or cocaine, can be obtained from the National Poisons Information Service or TOXBASE.
- Patient must be transferred to intensive care as soon as practicable.
- Body temperature may be reduced by surface cooling with ice, or administration of cooled intravenous infusions.
- Treatment of malignant hyperthermia may also include:
- sodium bicarbonate
- mannitol
- furosemide (frusemide)
- dextrose/insulin infusion
- intravenous beta-blocker
History Notes
27/10/2022
East Region Formulary content agreed.
Reversal of local anaesthesia toxicity
Soya oil
Intralipid 20% infusion 500ml bags
As per local protocol.
History Notes
06/09/2023
Intralipid bottles discontinued changed to bags
27/10/2022
East Region Formulary content agreed.