The latest pharmacologic ventilator.

442 September 2014 A S anesthesiologists, we routinely administer drugs that compromise a patient’s ability to breathe, and dealing with the consequences can be a challenge. However, our jobs may be getting easier. In this issue, Roozekrans et al.1 present two small, human studies on male volunteers conducted in The Netherlands on a promising new breathing stimulant compound, GAL021, being developed by Galleon Pharmaceuticals (Horsham, PA). Additional first-in-human safety and pharmacokinetic studies of GAL021 conducted in Belgium are to be published in an upcoming issue of the British Journal of Anaesthesia. Opioids are the most effective drugs for acute pain management. However, they cause opioidinduced respiratory depression (OIRD), which is a significant contributor to many adverse perioperative respiratory events.2 Opioid sensitivity is unpredictable and impacted by polypharmacy, age, and comorbidities, including obesity and sleep apnea. Opioids, along with analgesia, cause sedation, hypoventilation, loss of responsiveness to hypoxia and to hypercapnia, irregular breathing with periods of apnea, and loss of upper airway muscle tone. A drug that minimizes OIRD would have significant clinical utility. Naloxone is effective, reliable, and widely-available to reverse OIRD, but, unfortunately, it reverses analgesia, as well. GAL021 is being developed as an agent to treat OIRD with no effect on opioid analgesia. In this well-conducted, two-part study, patients received steady-state drug infusions of lowor high-dose alfentanil coadministered with steady-state infusions of placebo or lowor high-dose GAL021. Study 1 tested GAL021 efficacy in reversing established OIRD. Study 2 addressed nonrespiratory endpoints such as hemodynamics, analgesia, and sedation. In short, without altering analgesia, sedation, or hemodynamics, GAL021 reversed some of the hypoventilation induced by alfentanil. GAL021 was well tolerated with “sweating and feeling warm” and “infusion site pain” as its main adverse effects.