Intrathecal morphine for postoperative analgesia in an infant with bronchopulmonary dysplasia following upper abdominal surgery

Abstract

We present a case of severe bronchopulmonary dysplasia in which intrathecal morphine was successfully used for analgesia after a Nissen fundoplication and gastrostomy. Various options for anaesthesia are discussed with the knowledge that two previous procedures had been complicated by congestive cardiac failure and increased respiratory failure.

Epidural and subarachnoid blockade in children

“…The agents most commonly used are tetracaine (amethocaine) commonly used in North America and bupivacaine, the most suitable agent available in the UK. There is little experience with the use of subarachnoid opioids in children but their use has been described in small numbers of patients usually to provide prolonged postoperative analgesia [152].…”

“…It is not usually possible to determine the extent of subarachnoid blockade accurately in children but the duration of anaesthesia sufficient for surgery is consistently less than that seen in adults. Two series have demonstrated a mean duration of subarachnoid anaesthesia of 71 min [152] and 84 min [140] and it can only be relied upon for procedures expected to last less than 60 min. This brief duration of subarachnoid blockade is also reflected in the time taken to regain motor function following subarachnoid anaesthesia [62].…”

Correspondence

“…Standard noninvasive monitors were applied. The radial Numerous strategies to prevent VAE have been described artery was cannulated for direct arterial pressure (1). Doppler ultrasonic flow transducer, infrared carbon monitoring.…”

“…In our strategy to prevent VAE, we used a thin rubber tourniquet, which has been criticized by Hewer & Logue (1). However, we carefully applied jugular venous References compression (3) to avoid occlusion of the carotid vessels rate was reduced to 10 mg·kg −1 ·h −1 immediately after Deep sedation with propofol for correct positioning of the child, and further reduced to paediatric radiotherapy 5 mg·kg −1 ·h −1 throughout the course of radiotherapy as SIR-We were interested to read Dr Scheiber's article (1) deemed appropriate by the anaesthetist. The overall mean reporting the use of a propofol infusion to obtain deep total dose of propofol for radiotherapy treatment was sedation for preschool children undergoing radiotherapy.…”

“…SIR-Inhalation induction of anaesthesia is a popular technique in paediatric practice. Various strategies, Sir-I read with interest the case report of intrathecal including the use of flavoured or disguised masks, have morphine for a child with bronchopulmonary dysplasia been devised to make the event more pleasant for the (1). We reported (2) on the use of low dose caudal morphine child.…”