Effects of Intrathecal Morphine on the Ventilatory Response to Hypoxia

Bailey, Peter L.; Lu, Jeff Zhiqiang; Pace, Nathan L.; Orr, Joseph A.; White, Julia L.; Hamber, Elizabeth A.; Slawson, Matthew H.; Crouch, Dennis J.; Rollins, Douglas E.

doi:10.1056/nejm200010263431705

Cited by 118 publications

(69 citation statements)

References 30 publications

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“…The combined use of ITM and intravenous morphine (via PCA) runs the theoretical risk of postoperative respiratory depression. Several studies have shown that the combination is safe and respiratory depression rarely occurs [23,24], with such a small dose of ITM (0.1 or 0.2 mg). Pruritus, a side-effect of ITM [31,35] was not a clinical problem in our patients.…”

Section: Discussionmentioning

confidence: 99%

Use of intrathecal morphine for postoperative pain relief after elective laparoscopic colorectal surgery

Sh¹,

Onsiong

Chiu³

et al. 2002

Anaesthesia

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SummaryLaparoscopic surgery has become popular in recent years, but few studies have addressed analgesia for this type of surgery. We conducted a prospective double-blind randomised trial on 36 cases of laparoscopic colorectal surgery to determine the influence of intrathecal morphine on postoperative pain relief. All patients received a subarachnoid block with local anaesthetic in addition to general anaesthesia. One group also received intrathecal morphine. A patient-controlled analgesic (PCA) device was prescribed for pain control postoperatively and the visual analogue score (VAS) was used for pain assessment. The group who received intrathecal morphine used significantly less morphine. There were no adverse cardiovascular effects of the combined anaesthetic technique. Nausea and vomiting remained the main side-effect of intrathecal morphine but this was easily treated with anti-emetics.

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Section: Discussionmentioning

confidence: 99%

Use of intrathecal morphine for postoperative pain relief after elective laparoscopic colorectal surgery

Sh¹,

Onsiong

Chiu³

et al. 2002

Anaesthesia

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“…Concerns have been raised regarding the potential for ventilatory depression and delayed extubation when IT morphine is used as part of a fasttracking program, especially with the concomitant use of iv analgesics and sedatives. 8,18,19 IT sufentanil is known to provide an intense and fast-onset analgesia. 8,9 We postulated that the combination of IT mor- phine and sufentanil could avoid deleterious effects and increase patient comfort because of their different peaks of activity.…”

Section: Extubation Postoperative Analgesia and Complicationsmentioning

confidence: 99%

Intrathecal sufentanil-morphine shortens the duration of intubation and improves analgesia in fasttrack cardiac surgery

Béttex

Schmidlin

Chassot

et al. 2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To compare the effect of combined intrathecal morphine and sufentanil with low-dose iv sufentanil during propofol anesthesia for fast-track cardiac surgery.M Me et th ho od ds s: : Twenty-four consecutive patients with normal cardiopulmonary function who were scheduled for elective cardiac surgery were randomized to receive either a continuous iv infusion of sufentanil 0.9 to 1.8 µg·kg -1 ·min -1 (13 patients), or a single lumbar intrathecal dose of sufentanil 50 µg and morphine 500 µg (11 patients). We prospectively studied perioperative analgesia, time to extubation and early postoperative maximal inspiratory capacity in the two groups. In the intensive care unit, the medical and nursing staff were blinded to the analgesic technique.R Re es su ul lt ts s: : Intrathecal sufentanil morphine allowed a shorter duration of intubation (104 ± 56.5 min vs 213 ± 104 min; P = 0.01), reduced the need for postoperative analgesia with nicomorphine (equipotent to morphine) (0.7 ± 0.4 mg·hr -1 vs 1.2 ± 0.4 mg·hr -1 ; P = 0.008) and improved postoperative maximal inspiratory capacity (53.4 ± 16.1 vs 38.4 ± 12.5% of the norm; P = 0.05).C Co on nc cl lu us si io on n: : In low-risk patients undergoing coronary artery bypass graft or valve surgery, combined intrathecal sufentanil and morphine with a target-controlled infusion of propofol satisfies the goals of fast-track cardiac surgery. (0,7 ± 0,4 mg·h -1 vs 1,2 ± 0,4 mg·h -1 ; P = 0,008) et une amélioration de la capacité inspiratoire maximale postopératoire (53,4 ± 16,1 vs 38,4 ± 12,5 % de la norme ; P = 0,05 AST-TRACK cardiac surgery entails early postoperative extubation with intense control of pain and rapid transfer to the ward and is mostly applied to patients who have well-preserved pulmonary and ventricular function. C Ca ar rd di io ot th ho or ra ac ci ic c A An ne es st th he es si ia a, , R Re es sp pi ir ra at ti io on n a an nd d A Ai ir rw wa ay y

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“…Although usually safe, opioids can cause potentially fatal depression of breathing. In vivo evaluation of drug effects on breathing is usually achieved by measuring depression of hypoxic and hypercapnic ventilatory responses (Bailey et al, 2000;Dahan and Teppema, 2003;Mitsis et al, 2009). These measurements give reliable estimation of drug-induced changes in chemoreflex responsiveness; however, brainstem respiratory control mechanisms are also modulated by inputs from higher centers in the cortex (Colebatch et al, 1991;Corfield et al, 1998;McKay et al, 2003McKay et al, , 2008.…”

Section: Introductionmentioning

confidence: 99%

Opioids Depress Cortical Centers Responsible for the Volitional Control of Respiration

Pattinson¹,

Governo²,

MacIntosh³

et al. 2009

Journal of Neuroscience

156

138

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Respiratory depression limits provision of safe opioid analgesia and is the main cause of death in drug addicts. Although opioids are known to inhibit brainstem respiratory activity, their effects on cortical areas that mediate respiration are less well understood. Here, functional magnetic resonance imaging was used to examine how brainstem and cortical activity related to a short breath hold is modulated by the opioid remifentanil. We hypothesized that remifentanil would differentially depress brain areas that mediate sensoryaffective components of respiration over those that mediate volitional motor control. Quantitative measures of cerebral blood flow were used to control for hypercapnia-induced changes in blood oxygen level-dependent (BOLD) signal. Awareness of respiration, reflected by an urge-to-breathe score, was profoundly reduced with remifentanil. Urge to breathe was associated with activity in the bilateral insula, frontal operculum, and secondary somatosensory cortex. Localized remifentanil-induced decreases in breath hold-related activity were observed in the left anterior insula and operculum. We also observed remifentanil-induced decreases in the BOLD response to breath holding in the left dorsolateral prefrontal cortex, anterior cingulate, the cerebellum, and periaqueductal gray, brain areas that mediate task performance. Activity in areas mediating motor control (putamen, motor cortex) and sensory-motor integration (supramarginal gyrus) were unaffected by remifentanil. Breath hold-related activity was observed in the medulla. These findings highlight the importance of higher cortical centers in providing contextual awareness of respiration that leads to appropriate modulation of respiratory control. Opioids have profound effects on the cortical centers that control breathing, which potentiates their actions in the brainstem.

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Effects of Intrathecal Morphine on the Ventilatory Response to Hypoxia

Abstract: Depression of the ventilatory response to hypoxia after the administration of intrathecal morphine is similar in magnitude to, but longer-lasting than, that after the administration of an equianalgesic dose of intravenous morphine.

Cited by 118 publications

References 30 publications

Use of intrathecal morphine for postoperative pain relief after elective laparoscopic colorectal surgery

Use of intrathecal morphine for postoperative pain relief after elective laparoscopic colorectal surgery

Intrathecal sufentanil-morphine shortens the duration of intubation and improves analgesia in fasttrack cardiac surgery

Opioids Depress Cortical Centers Responsible for the Volitional Control of Respiration

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