The effects of opium on the cardiovascular system: a review of side effects, uses, and potential mechanisms.

BACKGROUND: In Iran, as in many other Asian and Middle Eastern countries, some believe that opium has beneficial effects on cardiovascular system. Dependent patients suppose that opium has positive effects on cardiovascular function and can prevent or improve cardiovascular diseases; however, only few comprehensive studies evaluating such effects have been performed. OBJECTIVES: In this study, we sought to clarify the effect of opium on cardiovascular problems by incorporating the previous findings and the current information on the issue and to explain the possible mechanisms of this effect. METHODS: The available human studies published up to October 30, 2019, were searched in different databases. Case-control, cohort, and cross-sectional studies were retrieved. Papers published in English or those with an English abstract were included. The risk of bias for each included study was assessed based on the Newcastle-Ottawa Scale (NOS). We then categorized the effects of opium on cardiovascular problems along with its probable underlying mechanisms of action. RESULTS: In this study, most of the published articles suggested the adverse effects of opium on the cardiovascular system, including atherosclerosis, myocardial infarction, arrhythmia, low ejection fraction, and cardiovascular mortality; however, some articles reported the beneficial or impartial effects of opium on the cardiovascular system. In this article, we have categorized all the effects of opium on cardiovascular system; also, the proposed mechanisms of action of opium in each of the above-mentioned disorders are summarized. CONCLUSION: Although the available evidences were incoherent, it was mostly suggested that opium use does not protect against or improve cardiovascular problems.

Opium and cardiovascular health: A devil or an angel?

Opioids have the highest rate of illicit drug consumption after cannabis worldwide. Opium, after tobacco, is still the most commonly abused substance in the Middle East. In addition to the ease of availability, one reason for the high consumption of opium in Asian countries might be a traditional belief among Eastern people and even medical staff that opium may have ameliorating effects on cardiovascular diseases (CVDs) as well as diabetes mellitus, hypertension, and dyslipidemia. Over the last decade, many studies have been performed on humans and animals to evaluate the interplay between opium consumption and stable coronary artery disease, acute coronary syndromes, and atherosclerosis. In this review, we conclude that opium consumption should be considered a risk factor for CVDs. Healthy individuals, as well as cardiac and diabetic patients, should be informed and educated about the hazardous effects of opium consumption on cardiovascular and other chronic diseases.

Cardiovascular and catecholamine changes after administration of pancuronium in distressed neonates.

Heart rate, blood pressure, transcutaneous gases, and catecholamine changes following intravenous injection of pancuronium were evaluated in seven ill newborn infants (birth weight: 1,280 to 4,500 g; gestational age, 29 to 42 weeks). Each infant was monitored continuously for 30 minutes before and 50 minutes after infusion of the paralyzing agent. There were no significant changes in transcutaneous gases, whereas significant increases in heart rate; systolic, diastolic, and mean blood pressures; and blood norepinephrine and epinephrine levels were found. The increase in heart rate lasted for 30 minutes, and the increase in blood pressure persisted for 50 minutes after administration of the drug. Because of the potential relationship between increased blood pressure and intraventricular hemorrhage and myocardial dysfunction, heart rate and blood pressure must be monitored during infusion of pancuronium in distressed newborns. These data suggest that pancuronium stimulates sympathetic activity in distressed newborns.

Lack of cardiovascular stimulation during endotracheal intubation in cardiac surgical patients anesthetized with diazepam-ketamine-pancuronium.

Anesthesia was induced with diazepam-ketamine-pancuronium in 12 adult patients scheduled for cardiac surgery. Intubation caused no significant changes in arterial blood pressure, heart rate, or plasma levels of norepinephrine and epinephrine. Circulatory stability was an advantage in critically ill patients.

Vecuronium: a new nondepolarizing neuromuscular-blocking agent. Clinical pharmacology, pharmacokinetics, cardiovascular effects and use in special clinical situations.

Vecuronium provides additional flexibility to the clinician using neuromuscular-blocking drugs. Its shorter duration of action, lack of significant cardiovascular effects and lack of dependence on the kidney for elimination provide clinical advantages over, or alternatives to, currently available, nondepolarizing neuromuscular-blocking drugs.

Cardiovascular effects of pancuronium bromide in mongrel dogs.

The cardiovascular effects of a new nondepolarizing muscle relaxant, pancuronium bromide, were studied in mongrel dogs. Small, but significant, increases in mean arterial blood pressure were observed after each of 2 intravenous doses (0.01 mg/kg and 0.1 mg/kg) were given. Heart rate increased significantly in dogs administered the larger dosage, and indexes of ventricular functions demonstrated a trend toward positive cardiac inotrophy after either the large or the small dose.

Neuromuscular and cardiovascular effects of pancuronium bromide in calves anesthetized with halothane.

Pancuronium bromide was administered to calves to define the dosage level necessary to produce surgical relaxation (90% to 99% reduction of base-line evoked, hindlimb digital-extensor muscle twitch tension). Initial dosage level requirement was 43 +/- 9 micrograms/kg of body weight. Calves with this degree of relaxation required 26 +/- 14 minutes to achieve 50% recovery and 43 +/- 19 minutes to achieve complete return of base-line muscle twitch. Calves given a repeat injection of pancuronium at base-line muscle twitch required 27 +/- 9 micrograms/kg to achieve relaxation similar to that of the 1st dose. The 2nd dose did not last as long as the 1st, with complete recovery occurring in 37 +/- 12 minutes. Maximum evoked tension occurred at 200- to 400-g resting tension on the hoof. There was an absence of heart rate or blood pressure changes after injection of relaxant and a variable and inconsistent fade response to train-of-four and tetanic stimulus of the facial muscles. Acid-base values were alkalemic (pHa 7.5 +/- 0.08) when ventilation was controlled at eucapnia (PaCO2, 25 to 45 mm of Hg).

Antagonism of pancuronium neuromuscular blockade in halothane-anesthetized ponies using neostigmine and edrophonium.

Efficacy of neostigmine (0.04 mg/kg of body weight) and edrophonium (1 mg/kg), as antagonists for pancuronium neuromuscular blockade in halothane-anesthetized ponies, was evaluated. Neostigmine and edrophonium were satisfactory antagonists, with edrophonium having a significantly (P less than 0.01) more rapid onset of action than did neostigmine. Muscarinic activity of neostigmine and edrophonium was also evaluated. Neither antagonist was administered with atropine. Gastrointestinal effects, increased salivation, and increased airway secretions were minimal with edrophonium, but were marked after neostigmine. Blood pressure increased within 1 to 2 minutes of antagonist administration. Heart rate decreased after edrophonium injection, but this occurred after blood pressure increase. Heart rate increased or did not change after neostigmine administration.

Cardiovascular effects produced by a combination of d-tubocurarine and pancuronium in dogs.

The effect on the cardiovascular system of a combination of pancuronium (0.048 mg/kg) and d-tubocurarine (0.288 mg/kg) was studied in five conditioned dogs anesthetized with fentanyl. Changes in heart rate, mean arterial pressure, central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, stroke volume, cardiac output, systemic vascular resistance and pulmonary vascular resistance were recorded 2, 5, 10, 20, 30, 40 and 50 minutes after administration of the drug combination. Arterial blood samples were assayed for estimation of histamine levels. There was a significant fall in central venous pressure and mean arterial pressure at 2 minutes (p less than 0.05) and a significant rise in heart rate at 2 and 5 minutes (p less than 0.05). These changes were not significant at 10 minutes. There was no significant change in the other parameters measured and no significant release of histamine. It is concluded that the smaller doses of pancuronium and d-tubocurarine used in combination in dogs do not completely attenuate the cardiovascular effects of either drug when used independently, but that the changes are transient and no longer significant at 10 minutes.

Snake venom components and their applications in biomedicine.

Snake envenomation is a socio-medical problem of considerable magnitude. About 2.5 million people are bitten by snakes annually, more than 100,000 fatally. However, although bites can be deadly, snake venom is a natural biological resource that contains several components of potential therapeutic value. Venom has been used in the treatment of a variety of pathophysiological conditions in Ayurveda, homeopathy and folk medicine. With the advent of biotechnology, the efficacy of such treatments has been substantiated by purifying components of venom and delineating their therapeutic properties. This review will focus on certain snake venom components and their applications in health and disease.

A comparative clinical study of dioxonium and pancuronium as muscle relaxants in small children.

Dioxonium (30, 40, and 60 microgram/kg i.v.), a new depolarizing agent, weas compared with pancuronium (0.05 and 0.1 mg/kg i.v.) as a muscle relaxant in combination anesthesia during general surgical operations in small children. Generally, the conditions during intubation, maintenance of anesthesia, and in the recovery room were comparable after both drugs. There were no differences in the cardiovascular responses either. However, a wider intra- and interindividual variation in the drug response was observed after dioxonium, especially after repeated administrations.

[The influence on the cardiovascular system of etomidate infusion anaesthesia combined with fentanyl/nitrous oxide (author's transl)]. / Die Wirkung der Etomidat-Infusionsanästhesie in Kombination mit Fentanyl/Stickoxydul auf das Kreislaufverhalten.

Blood pressure and heart rate after the application of etomidate, soluble in alcohol 70% (a ml approximately or equal to 125 mg) and supplemented by fentanyl under controlled respiration with N2O/O2 as an continuous infusion for anaesthesia has been investigated during surgery. After the administration of fentanyl/etomidate (Hypnomidate)/succinylcholine the patients were intubated. Then the infusion of etomidate began with 1.5-2 mg/min for ten minutes, whereafter the dose was reduced to 0.15-0.25 mg/min. The continuous infusion of etomidate was stopped about 20 minutes before the end of the operation. The influence on the cardiovascular system during the whole operation was very minimal. The anaesthesia could be handled without any problems. Therefore the application of etomidate as a continuous infusion in combination with fentanyl and nitrous oxide 66% seems to be an effective technique of intravenous anaesthesia.