Biphasic Depression of Ventilatory Responses to CO2 Following Epidural Morphine

Kafer, Enid R.; Brown, J. T.; Scott, Darren M.; Findlay, J. W. A.; Butz, Robert F.; Teeple, Edward; Ghia, Jawahar N.; Bridenbaugh, L. Donald

doi:10.1097/00132586-198312000-00048

Cited by 14 publications

(21 citation statements)

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“…The onset of delayed respiratory depression is usually 6 to 12 hours and may persist for up to 24 hours after administration. 10,11 Epidural analgesia with morphine is recommended with a continuous infusion of 200 to 400 µg/ hr. 12 The medication error described in this case report resulted in a continuous infusion of 8 mg/hr.…”

Section: Discussionmentioning

confidence: 99%

Opiate Intoxication Caused by Epidural Infusion of Morphine: A Case Report of a Near Fatal Medication Error

et al. 2019

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Introduction Epidural infusion of local anesthetics with opioids is widely used for pain control during the perioperative—and peripartum—periods. Selection of the opioid, appropriate dosing, and follow‐up by the acute pain service are critical in providing safe postoperative epidural analgesia. Case Report Summary A 71‐year‐old man was scheduled for a parastomal hernia repair with midline laparotomy. The parastomal hernia was a complication from a previously performed colectomy for ulcerative colitis. Preoperatively, the patient received a lower thoracic epidural catheter. The epidural infusate (0.2% ropivacaine with 0.5 µg/mL sufentanil) was prepared and double‐checked by holding area nurses. The fact that the right prescription medication label partially covered a morphine label went unnoticed. The intraoperative phase was characterized by stable parameters. Postoperatively, it was not possible to demonstrate an epidural nerve block. No pain was reported, and the patient could be transferred to the ward. The patient developed coma and delayed respiratory depression after discharge to the surgical ward, requiring intensive care unit admission and naloxone administration. Analysis of the syringe content revealed the presence of morphine (1 mg/mL). Discussion Color‐coded prefilled syringes combined with the use of an epidural specific syringe connector to prevent cross‐connections should become standard practice. In addition, delayed respiratory depression should be considered after epidural administration of morphine.

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Section: Discussionmentioning

confidence: 99%

Opiate Intoxication Caused by Epidural Infusion of Morphine: A Case Report of a Near Fatal Medication Error

et al. 2019

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“…Epidural morphine induces prolonged (11) and biphasic respiratory depression (12,13). The early respiratory depression seen during the first hours after epidural administration appears to be related to the plasma concentration of morphine (14).…”

Section: Discussionmentioning

confidence: 99%

Pupillary Diameter and Ventilatory CO2 Sensitivity after Epidural Morphine and Buprenorphine in Volunteers

Ravnborg

Jensen

et al. 1987

Anesthesia & Analgesia

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N-H, HOLK IK. Pupillary diameter and ventilatory C 0 2 sensitivity after epidural morphine and buprenorphine in volunteers. Anesth Analg 1987;66:847-51.The aim of this study was to correlate pupillary diameter with respiratory depression for 20 hr after epidural administration of morphine or buprenorphine. Pupillary diameter and the ventilatory sensitivity to CO, were measured in six healthy volunteers at various times (0, 0.5, 1 , 2, 3, 4, 6 , 8, 10, 12, and 20 hr) in two sessions, separated by at least 1 week, at which either epidural morphine, 4 mg, or epidural buprenorphine, 0.15 mg, was administered randomly in a double-blind manner. Three of the six volunteers received 0.3 mg buprenorphine epidurally in a third session. Pupillary diameter was measured with a modified Essilor pupillometer. The ventilatory CO, sensitivity was measured by a modified Read rebreathing technique. The ventilatory parameters measured were mouth occlusion pressure during the first 0.1 sec of inspiration (Po,l), end-tidal CO, PET^^^), tidal volume (VT) and respiratory rate (RR). Slopes of the h e a r regression lines (P,,/CO,, vT/coz, VEICO,, and RRICO,) and the intercept values of the regression lines and PET^^^ = 7.2 kPa (Po 1:7.2, V~: 7 . 2 , V~: 7 . 2 , and RR: 7.2) were calculated. Pupillary diameter after epidural morphine was smallest at the second hour and had returned to normal after eight hours. After epidural buprenorphine there were two periods of miosis, one at 1-3 hr, the other at 10 hr. With epidural morphine, a statistically significant correlation (P < 0.05) was found between pupillary diameter and VEICO~, V~: 7 . 2 , P,,:7.2, and V~: 7 . 2 . With epidural buprenorphine 0.15 mg a significant correlation was found between pupillary diameter and V~: 7 . 2 and Po ,:7.2. With epidural buprenorphine 0.3 mg the correlations between pupillary diameter and VE:Co,, k 7 . 2 , and P0.,:7.2 were significant. The results indicate that the neural control of respiration and of pupillary diameter is influenced synchronously by epidural opioids and that the pupillary response may serve as an indicator of respiratory depression.The dose-dependent pupillary constriction produced in humans by opioids is easily observed and quantified. The possibility of correlation between miosis and respiratory depression during analgesic therapy with opioids has not been evaluated. With the introduction of epidural opioid administration, the necessity to monitor respiration has been accentuated because of late respiratory depression. Several reports on life-threatening late respiratory depression (1,2) have restricted the use of epidural opioid administration in pain treatment.The aim of this study was to measure changes in pupillary diameter after epidural administration of

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“…Cette inhibition se fait par l'intermédiaire de récepteurs aux opiacés présents au niveau de la corne postérieure de la moelle [5]. L'analgésie obtenue est prolongée et de qualité, au prix d'un risque de dépression respiratoire dose-dépendant, parfois sévère [6][7][8][9][10] liée à la résorption systémique de l'opiacé utilisé et, pour les opiacés hydrophiles, à une migration céphaliques vers les centres respiratoires après un délai moyen de 8 à 10 h. C'est la méthode la plus efficace pour inhiber les récepteurs médullaires aux opiacés [11].…”

Section: Analgésie Locorégionale Périmédullaireunclassified

Prise en charge de la douleur après césarienne sous anesthésie locorégionale

Wallois

2015

Le Praticien en Anesthésie Réanimation

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Biphasic Depression of Ventilatory Responses to CO2 Following Epidural Morphine

Cited by 14 publications

References 0 publications

Opiate Intoxication Caused by Epidural Infusion of Morphine: A Case Report of a Near Fatal Medication Error

Opiate Intoxication Caused by Epidural Infusion of Morphine: A Case Report of a Near Fatal Medication Error

Pupillary Diameter and Ventilatory CO2 Sensitivity after Epidural Morphine and Buprenorphine in Volunteers

Prise en charge de la douleur après césarienne sous anesthésie locorégionale

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