Hemodynamic Effects of Morphine and Morphine–Nitrous Oxide in Valvular Heart Disease and Coronary-artery Disease

Stoelting, Robert K.; Gibbs, Philip S.

doi:10.1097/00000542-197301000-00012

Cited by 74 publications

(14 citation statements)

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“…Another possible explanation for the observed effect of the epidural injection is an interaction of the epidural block with another component of the anesthetic, such as nitrous oxide. Nitrous oxide activates the sympathetic nervous system (5,6). However, the concentration of nitrous oxide was constant throughout the case.…”

Section: Discussionmentioning

confidence: 99%

Improvement in Blood Flow During Lower Extremity Microsurgical Free Tissue Transfer Associated with Epidural Anesthesia

Weber

1988

Anesthesia & Analgesia

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Patients undergoing reconstructive surgery involving free tissue transfer from one part of the body to another provide an interesting challenge to the anesthetist. The immediate success of this procedure depends on maintainance of adequate perfusion through the microsurgical arterial and venous anastomoses. A technique that optimizes blood flow to the free flap and minimizes the possibility of vascular spasm and flap ischemia is needed. A case is presented in which a patient developed intraoperative flap ischemia. The problem was quickly and reproducibly eliminated by reinjection of an epidural block, thereby possibly preventing loss of the free muscle flap. Case ReportA 53-year-old, 100-kg man with chronic draining osteomyelitis of the right tibia was brought to the operating room for a rectus abdominis free muscle flap transfer to the distal third of the right leg. Preoperative angiography showed patency of only the posterior tibial artery with good distal run-off.Physical evaluation showed a physical status I1 patient with all laboratory values within normal limits. The patient preferred regional anesthesia, and epidural anesthesia was planned.The patient was premedicated with morphine sulfate 10 mg and scopolamine 0.4 mg IM. On amval in the operating room his arterial blood pressure was

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Section: Discussionmentioning

confidence: 99%

Improvement in Blood Flow During Lower Extremity Microsurgical Free Tissue Transfer Associated with Epidural Anesthesia

Weber

1988

Anesthesia & Analgesia

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“…The effects of N20 on systemic vascular resistance during balanced anaesthesia have been found to vary (8,(11)(12)(13)(14)(15)(16). However, there is no general explanation for these differing responses to N20.…”

Section: Discussionmentioning

confidence: 99%

Haemodynamic Response to Nitrous Oxide during High‐Dose Fentanyl Pancuronium Anaesthesia

Meretoja

Takkunen

Heikkilä

et al. 1985

Acta Anaesthesiol Scand

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Ten patients subjected to coronary by-pass surgery were studied to determine the haemodynamic effects of replacing Fio2 1.0 normoventilation with nitrous oxide in oxygen (Fio2 0.3) after induction of anaesthesia with fentanyl (50 micrograms/kg), flunitrazepam and pancuronium. In all patients the application of N2O decreased systemic arterial pressures by an average of 10% (P less than 0.001), but left pulmonary arterial pressures and systemic vascular resistance unchanged. The slight bradycardia induced was associated with moderate depression of the cardiac index and the left ventricular stroke work index (P less than 0.001) at the time when the rate-pressure product was decreased by 20% (P less than 0.001). The cardiac depression produced by N2O was most prominent in patients with left ventricular wall hypokinesia and an ejection fraction below 55%, in whom the cardiac work index was diminished by 29%. The replacement of oxygen with nitrous oxide in oxygen during high-dose fentanyl-pancuronium anaesthesia seems not to be associated with sympathetic stimulation, and the myocardial depressant effect of N2O should be weighed against the possible reduction in myocardial oxygen consumption with special care in patients with compromised myocardial function.

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“…cardiac output secondary to a lowered heart a significant change only in central venous rate in non-cardiac patients (PRYS-ROBERTS pressure which increased concomitant with a & KELMAN 1967). However, this might have rise in arterial Pco2, When the latter was been due to the administration of nitrous normalized, the central venous pressure oxide, which has been shown to give rise to a decrease in heart rate, arterial blood pressure and cardiac index when used together with morphine or fentanyl for anaesthesia in cardiac patients (STOELTING & GIBBS 1973, STOELTINC et al 1975. LAPPAS et al (1975) suggested that nitrous oxide depresses the left ventricular performance during morphine anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Effects of Neurolept Anaesthesia in Patients with Coronary Artery Disease

Tydén

Westerholm

1979

Acta Anaesthesiol Scand

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An anaesthetic technique comprising a combination of phenoperidine (0.1 mg . kg-1), diazepam (0.06 mg . kg-1) and pancuronium bromide (0.1 mg . kg-1) with controlled ventilation was evaluated in 12 patients with severe coronary artery disease. The heart rate, cardiac output and mean arterial blood pressure did not change significantly between the preinduction and postinduction measurements. The right atrial pressure and pulmonary capillary wedge pressure decreased significantly by 33% and 36%, respectively, probably due to the influence of positive-pressure ventilation. There was no depression of the left ventricular performance.

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Hemodynamic Effects of Morphine and Morphine–Nitrous Oxide in Valvular Heart Disease and Coronary-artery Disease

Cited by 74 publications

References 0 publications

Improvement in Blood Flow During Lower Extremity Microsurgical Free Tissue Transfer Associated with Epidural Anesthesia

Improvement in Blood Flow During Lower Extremity Microsurgical Free Tissue Transfer Associated with Epidural Anesthesia

Haemodynamic Response to Nitrous Oxide during High‐Dose Fentanyl Pancuronium Anaesthesia

Cardiovascular Effects of Neurolept Anaesthesia in Patients with Coronary Artery Disease

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