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Searching for a general anaesthesia protocol for rapid detoxification from opioids

Published online by Cambridge University Press:  16 August 2006

P. Lorenzi ,
M. Marsili ,
S. Boncinelli ,
L. P. Fabbri ,
P. Fontanari ,
A. M. Zorn ,
P. F. Mannaioni  and
E. Masini
P. Lorenzi
Affiliation:
Department of Clinical Pathophysiology, Unit of Anaesthesia and Intensive Care, University of Florence, Careggi General Hospital, Florence, Italy
M. Marsili
Affiliation:
Department of Clinical Pathophysiology, Unit of Anaesthesia and Intensive Care, University of Florence, Careggi General Hospital, Florence, Italy
S. Boncinelli
Affiliation:
Department of Clinical Pathophysiology, Unit of Anaesthesia and Intensive Care, University of Florence, Careggi General Hospital, Florence, Italy
L. P. Fabbri
Affiliation:
Department of Clinical Pathophysiology, Unit of Anaesthesia and Intensive Care, University of Florence, Careggi General Hospital, Florence, Italy
P. Fontanari
Affiliation:
Department of Clinical Pathophysiology, Unit of Anaesthesia and Intensive Care, University of Florence, Careggi General Hospital, Florence, Italy
A. M. Zorn
Affiliation:
Department of Preclinical and Clinical Pharmacology, Unit of Clinical Toxicology, University of Florence, Careggi General Hospital, Florence, Italy
P. F. Mannaioni
Affiliation:
Department of Preclinical and Clinical Pharmacology, Unit of Clinical Toxicology, University of Florence, Careggi General Hospital, Florence, Italy
E. Masini
Affiliation:
Department of Preclinical and Clinical Pharmacology, Unit of Clinical Toxicology, University of Florence, Careggi General Hospital, Florence, Italy
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Abstract

The technique for ultra rapid opioid detoxification is designed to shorten the detoxification period by precipitating withdrawal by the administration of opioid antagonists such as naloxone or naltrexone. This procedure is performed under deep sedation or general anaesthesia to ensure that the patient does not consciously experience the acute withdrawal phase. This strategy has aroused controversy regarding the risk of sedation or anaesthesia in this situation. In the present study, ultra rapid opioid detoxification was carried out in 12 opiate-addicted patients by infusion of naloxone 4 mg for a period of 5 h using controlled ventilation during general anaesthesia, induced and maintained with midazolam, propofol and atracurium. Invasive cardiovascular and respiratory monitoring was performed, and withdrawal signs were evaluated using a graduated scale. Anaesthesia was maintained for another hour after the completion of the naloxone infusion. The validity of this anaesthesia protocol was confirmed by the relative lack of change in the patients’ haemodynamic values associated with mild signs of withdrawal.

Keywords

anaesthetic techniquesmidazolampropofolultrarapid opioid detoxificationnaloxone
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 16 , Issue 10 , October 1999 , pp. 719 - 727
Copyright
1999 European Society of Anaesthesiology

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