No abstract available.
Apnea* ; Doxapram*

The effect of a new analeptic, doxapram hydrochloride, on respiration has been studied in ten subjects anesthetized with thiopental or with nitrous oxide-oxygen-halothane. The results are as follows: 1) Respiratory stimulation was more pronounced in the group anesthetized with thiopental than that with nitrous oxide-oxygen-halothane. 2) The stimulatory effect lasted for four minutes. Subjects who received multiple doses of the drug, however, showed a cumulative effect. 3) Most cases showed moderate hypertensive effect and brief electrocardiographic change was observed in one of the ten.
Anesthesia, General* ; Doxapram* ; Electrocardiography ; Respiration* ; Thiopental

Postoperative respirative depression is a major factor limiting the use and safety of intraoperative narcotics. The need for an effective and safe narcotic antagonist to reverse this side effect without complication persists more than three decades of research. While narcotic induced respiratory depression can be reversed by appropriate, specific narcotic antagonist, it has not been possible to nulify the frespiratory depressant effects of narcotic without simultaneously nullifying the analgesic effects. Doxspram hydrochloride, respiratory stimulant, has been found to be significantly potent and selectively respirogenic. The present study undertakes to determine whether doxapram is ablereverse the respiratory depressnat effect of mrphine without mullifying the analgesic effects. In this study, 20 patients in 29 ASA class l patients given intravenous morphine, 0.5mg/kg, for elective surgery, produce postoperative respiratory depression. Inadequate spontaneous respiration at the end of anesthesia were treated with doxapram. The results were as follows: 1) Doxapram (mean 21.6mg) was able to reverse the respiratory depressant effect of morphine without nullifying the analgesic effect. 2) There was no hemodynamic alteration during reversal.
Anesthesia ; Depression ; Doxapram* ; Hemodynamics ; Humans ; Morphine* ; Narcotics ; Respiration ; Respiratory Insufficiency*

BACKGROUND: Although post-anesthetic shivering may be a temporary phenomenon, it leads to detrimental effects such as increased oxygen consumption, hypoxemia, and difficulty in monitoring. Doxapram is a relatively new treatment for post-anesthetic shivering, but there have been few reports about its minimum effective dose. The purpose of this study was to find the minimum dose of doxapram which would show an antishivering effect. METHODS: Sixty patients who had developed post-anesthetic shivering were divided into six groups of ten patients each. The groups were divided into a control group, which received normal saline, and the doxapram groups, which received five different doses of doxapram (0.15, 0.2, 0.5, 1.0, 1.5 mg/kg). The antishivering effect (2, 5, 10, 15 minutes after treatment), blood pressure, heart rate and temperature were compared among the groups. RESULTS: There was a significant difference in antishivering effect between the group which received normal saline and the groups which received doxapram; however, there was no significant difference within the groups which received doxapram. CONCLUSIONS: We conclude that the dose of doxapram required to achieve an antishivering effect is much less than that currently in use.
Anoxia ; Blood Pressure ; Doxapram* ; Heart Rate ; Humans ; Oxygen Consumption ; Shivering*

The purpose of this study is to investigate the effects of doxapram on the rates of spontaneous and neostigmine-induced recovery from neuromuscular block with vecuronium and atracurium. Following intravenous injection of either vecuronium (40 patients) or atracurium (40 patients), recovery index (RI) was measured without administering either doxapram or neostigmine (Group 1), or after administration of a combination of neostigmine 40 ug/kg and doxapram 1 mg/kg (Group 2), neostigmine 40 ug/kg (Group 3) or doxapram 1 mg/kg (Group 4) when twitch tension returned to 25% block of train of four response, each of the four group had 10 patients. The results were such that RI was significantly prolonged after vecuronium in the presence of doxapram compared with Group 1 (13.5 min vs 8.2 min). There was no significant difference in the RI after atracurium in the presence of doxapram compared with Group 1 (7.0 min vs 7.1 min). There was rapid recovery which was significant when neostigmine was administered with or without doxapram (2.4 min vs 2.3 min respectively after vecuronium; 2.3 min vs 2.4 min respectively after atracurium). The authors conclude that administration of doxapram in situation where neuromuscular block with vecuronium is not adequately antagonized does not contribute to rapid recovery from neuromuscular block.
Atracurium* ; Doxapram* ; Humans ; Injections, Intravenous ; Neostigmine ; Neuromuscular Blockade ; Vecuronium Bromide*

BACKGROUND: Shivering is a common postanesthetic complication. Because all shivering patients feel uncomfortable and increase oxygen consumption, various attempts have been made to prevent its occurrence or to control it. Among the pharmacological methods of treating shivering, meperidine has been known to be the most effective. This study was designed to evaluate whether there was any difference among meperidine, fentanyl, doxapram and normal saline in the treatment of post-anesthetic shivering. METHODS: Forty patients (ASA class I or II) who showed postoperative shivering were randomly assigned into four groups (n=10): Normal saline group: normal saline 5 ml, Doxapram group: doxapram 1.5 mg/kg, Meperidine group: meperidine 25 mg, Fentanyl group: fentanyl 25 microgram. And all patients received routine care: oxygen by T-piece and heat-reflective blanketrol (cincinati Subzero, U.S.A.). Evaluation of the state of shivering was done every 5 minutes from the beginning of the treatment by the same investigator who had injected the drugs intravenously for treatment of shivering. The age, sex, weight and duration of surgery were recorded. RESULTS: There were no significant statistical differences in age, sex, weight and duration of surgery among the four groups. By 5 minutes, 90% of doxapram group and 30% of meperidine group had stopped shivering. By 10 minutes, 90% of doxapram group and 70% of meperidine group had stopped shivering. But in fentanyl and normal saline group, only 20% had stoppd shivering by 10 minutes. CONCLUSIONS: We conclude that both meperidine and doxapram are effective on post-anesthetic shivering. In cases of patient with respiratory depression, doxapram is especially effective because it stimulates the respiratory center.
Doxapram* ; Fentanyl* ; Humans ; Meperidine* ; Oxygen ; Oxygen Consumption ; Research Personnel ; Respiratory Center ; Respiratory Insufficiency ; Shivering*

Doxapram as a potent respiratory stimulant is one of attempts to solve respiratory problem and has been known to be effective for many years. But one study suggested that the presence of doxapram retarded neostigmine-induced antagonism of vecuronium effect. So we studied the effect of doxapram on the reverse of neuromuscular block when doxapram was injected with different dose. 60 rabbits were divided into 6 groups. Vecuronium was used in Group 1~3 and Mivacurium was used in Group 4~6 as a muscle relaxant. When the first twitch of TOF response reappeared from the complete block with a muscle relaxant (T1 onset), we administered neostigmine 0.05 mg/kg and saline 0.3 ml i.v. in Group 1, 4(VS, MS), neostigmine 0.05 mg/kg and doxapram 0.5 mg/kg i.v. in Group 2, 5(VDP1, MDP1), and neostigmine 0.05 mg/kg and doxapram 3 mg/kg i.v. in Group 3, 6(VDP2, MDP2). Two recovery time, from T1 onset to T1 25% and from T1 25% to T1 75%, and TR(ratio ; T4 twitch/T1 twitch) at T1 75% were measured. For the hemodynamic effect of doxapram, Blood pressure, heart rate and arrythmia were observed before and after doxapram injection too. The results are as follows. 1) Recovery time from T1 onset to T1 25% are 2'30"+/-0'29"(min'sec") in VS, 3'07"+/-0'4l"(minsec") in VDPl, 1'49"+/-0'17"(min'sec") in VDP2, 2'34"+/-0'17"(min'sec") in MS, 2'41"+/-0'25"(min'sec") in MDP1, 1'52"+/-0'39"(min'sec") in MDP2. 2) Recovery time from T1 25% to T1 75% are 4'58"+/-0'52"(min'sec") in VS, 6'10"+/-1'17"(min'sec") in VDP1, 3'38"+/-0'33"(min'sec") in VDP2, 4'38"+/-'0'57"(min'sec") in MS, 5'10"+/-0'55"(min'sec") in MDP1, 3'15"+/-0'38"(min'sec") in MDP2. 3) TR at T1 75% are 76.6+/-7.7% in VS, 82.4+/-3.4% in VDP1, 83.8+/-4.5% in VDP2, 81.4+/-2.3% in MS, 89.8+/-2.3% in MDP1, 89.8+/-1.5% in MDP2. 4) Heart rate, cardiac rhythm, systolic and diastolic pressure before and after doxapram injection were not significantly changed. In conclusion, simultaneous administration of neostigmine and low dose doxapram delayed recovery from the neuromuscular block, but high dose doxapram did not.
Arrhythmias, Cardiac ; Blood Pressure ; Doxapram* ; Heart Rate ; Hemodynamics ; Neostigmine ; Neuromuscular Blockade* ; Rabbits ; Vecuronium Bromide*

Among the pharmacological methods treating postoperative shivering, there were no studies which compare the doses of doxapram. In this study, we have compared the effectiveness of doxapram in a placebo-controlled, double blind method. Sixty patients who shivered after operation under general anesthesia were examined. They were allocated randomly to receive normal saline(n=15), doxapram l mg/Kg(n=15), 1.5 mg/Kg(n=15) or 2 mg/Kg(n=15) from identical syringes intravenously. The investigator who gave the intravenous injection was unaware of the treatment received by the patient, and assessed the shivering. Both doxapram 1.5 mg/Kg and 2 mg/Kg were effective on shivering within 1~2 minutes after intravenous injection. In the saline group, all patients were still shivering 10 minutes after injection. In the doxapram 1 mg/Kg group, only two patients had stopped shivering by 6, 7 minutes after injection. In the doxapram 1.5 mg/Kg group, only three patients were shivering after injection. In the doxapram 2 mg/Kg group, only one patient was shivering after injection. We conclude that doxapram 1.5 mg/kg and 2 mg/kg were effective on postoperative shivering. And the results suggested that doxapram 2 mg/kg may be marginally superior to doxapram 1.5 mg/kg in this respect.
Anesthesia, General ; Double-Blind Method ; Doxapram* ; Humans ; Injections, Intravenous ; Research Personnel ; Shivering* ; Syringes

BACKGROUND: Doxapram hydrochloride is a respiratory stimulant that produces arousal effects in patients under anesthesia. We investigated the effects of doxapram on the recovery time and BIS index of patients administered desflurane inhalational anesthesia. METHODS: 40 patients who underwent general anesthesia using desflurane that had an ASA physical status of I or II received either 1 mg/kg of doxapram hydrochloride (doxapram group, n = 20) or normal saline (control group, n = 20) IV at end of surgery. Anesthetic recovery after the injection of doxapram was then determined based on the time to eye opening in response to verbal command, hand squeezing on command, time to extubation, and Aldrete recovery score. BIS index, systolic blood pressure, tidal volume and heart rate were recorded every minute for up to thirteen minutes. RESULTS: The doxapram group showed significantly shorter times to emergence based on eye opening in response verbal command (sec) (409 +/- 114 vs 320 +/- 116), hand squeezing on command (sec) (458 +/- 119 vs 351 +/- 114) and extubation (sec) (491 +/- 103 vs 418 +/- 79) compared to control group. The BIS score was not significantly different between the two groups. CONCLUSIONS: The Bis index was not significant higher in the doxapram group, with the exception of the measurement recorded at 2 minutes, however the recovery time from desflurane inhalational anesthesia was faster in the doxapram group than the control group.
Anesthesia ; Anesthesia, General ; Arousal ; Blood Pressure ; Doxapram ; Eye ; Hand ; Heart Rate ; Humans ; Isoflurane ; Tidal Volume

Doxapram is a peripheral and central respiratory stimulant, producing an increase in tidal volume and a slight increase in respiratory rate. It can temporarily overcome drug-induced respiratory and central nervous system depression, including that seen immediately postoperatively. However, it can also cause side effects, including laryngospasm and vomiting postoperatively. Doxapram-induced laryngospasm causes the increased respiratory efforts to induce more negative pleural pressure, thus causing a negative-pressure pulmonary edema.Therefore, doxapram should not be used if signs of upper airway obstruction are present.
Airway Obstruction ; Central Nervous System ; Depression ; Doxapram ; Laryngismus ; Pulmonary Edema ; Respiratory Rate ; Tidal Volume ; Vomiting