Nebulised naloxone

This appears to be a useful option when iv access is difficult and the patient is relatively stable.
The protocol specified nebulisation of 2 mg of naloxone with 3 mL of normal saline as empiric treatment for suspected opioid overdose or undifferentiated depressed respirations as long as the patient had some spontaneous respiratory effort, no apnoea, and no severe cardiorespiratory compromise.

BACKGROUND: Emergency medical services (EMS) traditionally administer naloxone using a needle. Needleless naloxone may be easier when intravenous (IV) access is difficult and may decrease occupational blood-borne exposure in this high-risk population. Several studies have examined intranasal naloxone, but nebulized naloxone as an alternative needleless route has not been examined in the prehospital setting.

OBJECTIVE: We sought to determine whether nebulized naloxone can be used safely and effectively by prehospital providers for patients with suspected opioid overdose.

METHODS: We performed a retrospective analysis of all consecutive cases administered nebulized naloxone from January 1 to June 30, 2010, by the Chicago Fire Department. All clinical data were entered in real time into a structured EMS database and data abstraction was performed in a systematic manner. Included were cases of suspected opioid overdose, altered mental status, and respiratory depression; excluded were cases where nebulized naloxone was given for opioid-triggered asthma and cases with incomplete outcome data. The primary outcome was patient response to nebulized naloxone. Secondary outcomes included need for rescue naloxone (IV or intramuscular), need for assisted ventilation, and adverse antidote events. Kappa interrater reliability was calculated and study data were analyzed using descriptive statistics.

RESULTS: Out of 129 cases, 105 met the inclusion criteria. Of these, 23 (22%) had complete response, 62 (59%) had partial response, and 20 (19%) had no response. Eleven cases (10%) received rescue naloxone, no case required assisted ventilation, and no adverse events occurred. The kappa score was 0.993.

CONCLUSION: Nebulized naloxone is a safe and effective needleless alternative for prehospital treatment of suspected opioid overdose in patients with spontaneous respirations.

Can nebulized naloxone be used safely and effectively by emergency medical services for suspected opioid overdose?
Prehosp Emerg Care, 2012 vol. 16 (2):289-292

6 thoughts on “Nebulised naloxone”

  1. This appears to be a useful option when iv access is difficult and the patient is relatively stable.
    If the patient is breathing and “relatively stable” (whatever that means) why would you give them Narcan?
    The desired effect of Heroin, at least from what the users tell me, is to get into a somnolent state without respiratory arrest. This is known as “on the nod”.
    By definition a patient on the nod is dosed, not overdosed. There is no reason in the world to treat a patient who is dosed.

    1. Thanks for your comments. Do you ever use naloxone diagnostically, and if so, do you think it’s worth knowing that the nebulised route is an option?
      I agree it’s hard to envisage exact circumstances where this would be indicated over other treatments, but I like knowing what works.
      By ‘relatively stable’, I meant no other indication for immediate vascular or osseous access
      There is no reason in the world to treat a patient who is dosed.
      Perhaps prehospital – but there are a couple of reasons to do it in the ED (not necessarily good ones – but it’s done)

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