Rapid Intravenous Injection of Fentanyl (FNT) Causes a Vagal‐Mediated Lethal Sudden Ventilatory Arrest in Anesthetized Rats

Abstract

Opioids have been used for analgesia and anesthesia mainly via activation of central opioid mu‐receptors (MORs). It also causes overdose deaths due to ventilatory failure, in which FNT is the deadest. Rapid intravenous (IV) injection of overdose FNT triggers a sudden death within a few minutes or even seconds, but the relevant mechanism remains unclear. Because bolus IV injection of FNT at a low dose produced a vagal‐mediated brief apnea (Zhuang et al, AJP 2012), This study was aimed to characterize the cardiorespiratory disorders responsible for the sudden death and determine the vagal role in generating the lethal ventilatory arrest. EMGs of external and internal intercostal (EMGEI and EMGII), thyroarytenoid and superior pharyngeal constrictor muscles (EMGTA and EMGSPC) were simultaneously recorded before and after IV injection of FNT in the anesthetized vagal intact and vagotomized rats. The optical fiber scope of an oral video camera was applied to visualize the vocal and pharyngeal responses. Immunohistochemical approach was used to define the presence of MOR expression in the pulmonary vagal sensory neurons retrogradely labeled by DiI. FNT induced an apnea or a lethal ventilatory arrest in a dose‐dependent manner associated with hypotension and bradycardia. The apnea/ventilatory arrest was characterized by silence of EMGEI with tonic discharges of EMGII, EMGTA, and EMGSPC, i.e., the central apnea (expiratory) coupled with vocal closure and pharyngeal constriction/collapse and chest wall rigidity (triple‐apnea). Vagotomy abolished the evoked cardiorespiratory responses. MOR expression in vagal pulmonary neurons, especially C‐neurons of the nodose and jugular ganglia. Our results suggest that rapid IV injection of FNT at a high dose uniquely causes a vagal‐mediated triple‐apnea, leading to the sudden death in anesthetized rats.