Epidural morphine reduces the riskof postoperative myocardial ischaemia in patients with cardiac risk factors

Ws, Beattie; Dn, Buckley; Jb, Forrest

doi:10.1007/bf03009738

Cited by 141 publications

(39 citation statements)

References 42 publications

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“…Sedation may improve outcome by reducing the stress response and its sequelae to these interventions [1]. However, sedation regimens also have potentially adverse effects which may increase morbidity and prolong the clinical course [2].…”

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confidence: 99%

Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit

et al. 1999

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SummaryDexmedetomidine, a highly selective and potent a 2 -adrenergic agonist, has a potentially useful role as a sedative agent in patients requiring intensive care. As part of a larger European multicentre trial, a total of 119 postoperative cardiac and general surgical patients requiring ventilation and sedation in an intensive care unit were enrolled in four centres in the United Kingdom. One hundred and five patients were randomly allocated to receive either dexmedetomidine or placebo with rescue sedation and analgesia provided by midazolam and morphine, respectively. Compared with the control group, intubated patients receiving dexmedetomidine required 80% less midazolam [mean 4.9 (5.8) mg.kg ¹1.h ¹1 vs. 23.7 (27.5) mg.kg ¹1.h ¹1 , p < 0.0001], and 50% less morphine [11.2 (13.4) mg.kg. Cardiovascular effects and adverse events could be predicted from the known properties of alpha-2 agonists. In conclusion, dexmedetomidine is a useful agent for the provision of postoperative analgesia and sedation.

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confidence: 99%

Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit

et al. 1999

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“…We have shown previously that intracerebroventricular administration of DPDPE increases cardiac tolerance to the arrhythmogenic effects of exogenous epinephrine. 19 In addition, in 1993 Beattie et al 20 established that epidural morphine infusion reduces the postoperative risk of ventricular tachyarrhythmias in patients with cardiac risk factors. In 2010, Ling et al 21 found that intrathecal administration of morphine decreased the IS/AAR ratio in rats with coronary artery occlusion and reperfusion.…”

Section: Discussionmentioning

confidence: 99%

Activation of Peripheral Delta Opioid Receptors Increases Cardiac Tolerance to Arrhythmogenic Effect of Ischemia/Reperfusion

Maslov

Oeltgen

Lishmanov

et al. 2014

Academic Emergency Medicine

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Objectives: The objective of this study was to investigate the role of peripheral l, d 1 , d 2 , and nociceptin opioid receptors agonists in the regulation of cardiac tolerance to the arrhythmogenic effect of ischemia/ reperfusion in rats.Methods: Anesthetized open-chest male Wistar rats were subjected to either 45 minutes of left coronary artery occlusion (phase 1a 10 minutes and phase 2b 35 minutes) and 2 hours of reperfusion in Experiment 1 or 10 minutes of ischemia and 10 minutes of reperfusion in Experiment 2. In Experiment 1, saline or vehicle controls and the mu-specific opioids dermorphin-H (Derm-H) and ([D-Ala2, N-Me-Phe4, Gly-ol5] enkephalin (DAMAGO); the delta-1-specific opioid D-Pen2,5enkephalin (DPDPE); nociceptin; and the delta-2-specific opioids deltorphin-II (Delt-II), Delt-Dvariant (Delt-Dvar), and deltorphin-E (Delt-E) were infused 15 minutes prior to ischemia. In Experiment 2, DPDPE, Delt-D, Delt-Dvar, and Delt-E were infused at 15 minutes prior to ischemia. The universal opioid receptor antagonist naltrexone, the peripherally acting antagonist naloxone methiodide, the selective d 1 antagonist 7-benzylidene naltrexone maleate, and the specific d 2 antagonist naltriben mesylate were infused 25 minutes prior to ischemia.Results: In Experiment 1, pretreatment with the l opioids Derm-H and DAMGO, DPDPE, and nociceptin at all doses tested did not reduce the incidence of ischemia-induced arrhythmias compared to controls during 45 minutes of ischemia. The d 2 opioids Delt-II (0.12 mg/kg), Delt-Dvar (0.3 mg/kg), and Delt-E (0.18 mg/kg) all demonstrated significant antiarrhythmic effects at the 150 nmol/kg dose compared to saline or vehicle controls. Nine of 19 animals treated with Delt-II were tolerant without ventricular arrhythmias to the arrhythmogenic effect of ischemia during the first 10 minutes of ischemia (phase 1a) and 11 of 19 were without ventricular arrhythmias during the following 35 minutes of ischemia (phase 1b). Delt-II also decreased the incidence of premature ventricular contractions and ventricular tachycardia by almost half during phase 1a. Delt-II did not affect the incidence of ventricular fibrillation (VF). Pretreatment with DeltDvar and Delt-E completely blocked the incidence of VF in phase 1b. Delt-E also decreased premature ventricular contractions by 50%, and the incidence of ventricular tachycardia decreased over twofold in phase 1b of ischemia. There was no enhanced tolerance by any of the delta-2 opioids to the arrhythmogenic effect of reperfusion after long-term ischemia. In Experiment 2, after 10 minutes of ischemia and 10 minutes of reperfusion, Delt-II (0.12 mg/kg) reduced the incidence of premature ventricular contractions and ventricular tachycardia compared to controls, and completely blocked the incidence of VF following 10 minutes of reperfusion. Delt-Dvar and Delt-E were without effect, as was DPDPE following 10 minutes of reperfusion. The antiarrhythmic effect of Delt-II during 10 minutes of ischemia and 10 minutes of reperfusion was completely blocked ...

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“…131 It is essential that the dose of neuraxial opioid be reduced with use in older patients. 132 Although some studies indicate that the incidence of pulmonary and cardiovascular comorbidity may be lower with neuraxial morphine than with systemic opioids, [133][134][135][136] the overall benefit is observed only when compared with intermittent IV doses and not when compared with IV infusion of opioids. 124,137,138 Neuraxial opioids are associated with side effects that could affect patients' quality of recovery.…”

Section: Neuraxial Opioidsmentioning

confidence: 99%

Postoperative Pain and Other Acute Pain Syndromes

Hanna

Ouanes

Tomas

2014

Practical Management of Pain

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Epidural morphine reduces the riskof postoperative myocardial ischaemia in patients with cardiac risk factors

Abstract: Perioperative myocardial ischaemia is a predictor of postoperative cardiac morbidity (PCM). (17,2 vs 50% P= 0,01), et de tachyarythmies (20,7 vs 50%, P < 0,05

Cited by 141 publications

References 42 publications

Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit

Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit

Activation of Peripheral Delta Opioid Receptors Increases Cardiac Tolerance to Arrhythmogenic Effect of Ischemia/Reperfusion

Postoperative Pain and Other Acute Pain Syndromes

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