Diazepam and Meperidine on Arterial Blood Gases in Patients with Chronic Obstructive Pulmonary Disease K. ZSIGMOND.

ELEM’ER

T

narcotic-analgesics

HAT

tion even no abnormality substantiated.’-4 barbiturates quently for

and

and/or

tranquilizers

in

are safe

some of sedative

the or

many

effects sedative the

of the

of

by

ventilatory

reports1-5

appeared

ventilation

whom

in

even

tilatory

on

healthy

a moderate

depression

induced

by

narcotic-analgesics

indispensable

for

premedication

*

Present

464

address: of

the Ann

Department

University Arbor, Mich.

of

of Michigan

as

sedatives

by

a routine

meperidine

vol-

undertaken.

drugs

can

medi-

are

not

in

lung

disease,

and

Methods patients

lung

study.

Their

are

shown

in

age

abnormal undergoing

lung

disease

General

Hospital.

studied monary

without the past

severe

this

study

with

chronic

I.

sex All

ob-

clinic

at

The

for

distribution

these

function treatment

in a special Laboratory,*

obwas

volunteered and

Table

monary

or without

with

disease

the had were

with

patients

lung

Twenty-four structive

have

to determine the influon ventilation and on depression produced by

in

Materials

of yen-

in we

preanesthetic

patients

decade. In order ence of diazepam the ventilatory structive

dede-

meperidine

volunteers,2’3’4’8’9

in surgical

and on

From the Department of Anesthesiology of Allegheny General Hospital, Pittsburgh, Pa. A preliminary abstract of this paper was presented at the 42nd Anniversary Congress of the Pan American Medical Association, November 26-30, 1967, Buenos Aires, Argentina.

ology Center,

it

Pa.

frequently anxiety.

chronic obstructive lung disease any adverse reaction during

be detrimental. Although

used

and

no ventilatory of ventilatory

induced human

pain,

are preoperative

de-

with pafunction,

degree

no

cation

the

human

with

the

of a Al-

various narcotic-analgesic or tranquilizer combinations

unteers, only a few4’#{176}’7dealt tients with abnormal pulmonary in

absence and

qualities drug.

tranquilizers to alleviate

healthy

narcotic-analgesics

desirable tranquilizer

patients

and/or needed

prssion

espe-

effect

disease

Since diazepam caused pression or potentiation

fre-

anesthesia the

depressant induced

though

practice, before

of potentiation

pression

with is well with are

Consequently,

ventilatory

lack

clinical

premedication

surgery.

of

ventila-

healthy volunteers of lung function Their combinations

used

cially

depress

in

M.D..* JOHN G. SHIVELY. M.D.. KATHLEEN FLYNN. B.S. Piftsburgh,

patients

tests in the the

and pul-

Allegheny

volunteers unit where

of

were the Pulequipment

AnesthesiMedical

*

This

eral

study Hospital, The

was

out

carried Pittsburgh,

Journal

at Allegheny

Pa., of

Clinical

during

Gen1965.

Pharmacology

DIAZEPAM

AND

MEPERIDINE

ON

TABLE Age

and

Sex

BLOOD

OASES

I

of 24 Patients

Distribution Chronic Lung

with

Disease Age Sex

Drug

study

groups

Diazepam, 0.15 mg/kg Meperidine, 1.5 mg/kg Diazepam, 0.15 mg/kg, and meperidine, 1.5 mg/kg

for immediate ‘rhree patients support

with

final

the

oxygen

evaluation. the insertion needle into

After arterial artery

resuscitation who required

and

infusion

of

the

start

5%

glucose

excluded

Male

Female

6

5

1

56.3 (43-69)

11

5

6

46.5 (27-59)

7

4

3

39.6 (28-48)

chloride

from

of a 20-gauge Riley the left brachial an in

0.2%

Control value (means ± S.D.)

Diazepam, 0.15 mg/kg

76.7±10.4

Meperidine, 1.5 mg/kg

66.5±

sodium

Diazepam, 0.15 mg/kg and

71.0±10.6

two 5 per

diazepam,

0.15

mg/kg,

meperidine,

Disease Given in Combination

values 10

the

than

begun.

1.5

or

If

less

1.5

mg/kg,

and

II

Chronic Lung Alone and

Torr

samples.

was

a

Two arterial at 10-minute

drawn

baseline

study

arm,

allowed.

differed

the

mg/kg,

contralateral

was then

Meperidine,

5 mimi

4.1

the

rest were as

cent,

TABLE

Intravenous medication and dose

of

determinations

intravenous

in Patients with Meperidine

Pa02

in

period samples intervals

of

and (yrs)

N

was at hand. respiratory

were

mean range

after

Diazepam

medication

mm

20

and

(means

mimi

± S.D.)

30

mm

60

mimi

78.3±13.1

72.7±10.9

72.9±11.5

49.3±12.5*

58.2±12.0

62.0±

1.5

63.8±

6.2

66.6±5.7

46.3±14.21

53.0±11.6

60.8±

8.8

67.8±

9.4

72.2±4.9

78.5±9.1

73.7±11.5

meperidine,

1.5

mg/kg

*Po.05

for

other tP
0.05),

dif-

diazepam

groups

the

narcotic-

significant

of

in

carbon

the

between

values

or

ventilatory

severe

to in

shift to

than

found

baseline

sion

diazepam decrease

greater

statistically

was

azepam safely diazepam

obstructive

inhalation

di-

IV.

and Fur-

it, since their greater change

and

diazepam-meperidine

Discussion depression

of further

response

analgesic

from

greater

Table

PaCO2

dioxide Since

in pH of the arterial blood poorly with the changes in PaCO2 as noted from Table IV. alone,

and

ventilatory

ference

in Pa02 alone.

to clearly identify will result in

Pa02

the

changes diazepam

increase in PaCO2, as shown in If a drug per se causes veildepression, a narcotic challenge

will help combination in

of

the addition caused no

or 1.

Fig. tilatory

fur-

GASES

by lack following

PaO2

diazepam the

BLOOD

thermore, meperidine

lack

As

di-

combination changes

in

significant

compared

azepam

caused elevation by

its

effect.

the of

Changes correlated Pa02 and As

corroborates

ON

tiated P5002

di-

This finding corroborates ventilatory depressant effect no

PaCO2 seen in

increase

no

of

dose

causes

MEPERIDINE

after

depressant

ever,

this

III,

occurred

which

pected, meperidine in PaCO2. This

azepam. lack of

Table

PaCO2

ventilatory

AND

of regional

postoperatively

anes-

without

the

IV

with Chronic Lung Meperidine Alone and

Disease Given in Combination

Diazepam

and

Control Intravenous medications and dose

value (means± S.D.)

Diazepam, 0.15 mg/kg

7.393±0.055

7.381

±0.031

7.379±0.024

7.405±0.015

7.407±0.024

7.408±0.026

Meperidine, 1.5 mg/kg

7.390

± 0.033

7.398

± 0.036

7.375

7.408

± 0.028

7.383

± 0.035

7.387

7.443

± 0.043

7.379

± 0.047*

7.374±

7.366

± 0.0571

7.376

± 0.0571

7.405 ± 0.0371

Torr 5 mm

values 10

after

mimi

.

medication 20

± 0.032

(means±

mm

30

S.D.) mimi

60

mm

± 0.030

Diazepam, 0.15 mg/kg, and meperidine, 1.5 mg/kg *

P