Intrathecal Morphine in Open Heart Surgery

Mathews, EdwardT.; Abrams, L. D.

doi:10.1016/s0140-6736(80)91875-9

Cited by 89 publications

(19 citation statements)

References 3 publications

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“…Antinociception may be prolonged; when morphine is utilized, it may persist for days following a single injection. 9 Unlike the response to local anaesthetics, there is no motor, sensory, or autonomic blockade. Paralysis and hypotension, therefore, are absent.…”

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confidence: 99%

Side effects of intrathecal and epidural opioids

1995

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confidence: 99%

Side effects of intrathecal and epidural opioids

1995

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“…To our knowledge, the "safe" time range has not been completely studied. Furthermore, Mathews and Abrams (27) reported that a single injection of intrathecal morphine as late as 50 min before heparin administration for cardiopulmonary bypass was safe and not associated with epidural or subdural hematomas in 40 patients. However, El-Baz and Golding (26), who in 30 patients used a continuous epidural infusion of morphine for pain relief after cardiac operations, inserted the catheter immediately prior to induction of anesthesia with no subsequent complications.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Epidural Anesthesia During Coronary Artery Bypass Surgery

Kirn??

Friberg

et al. 1994

Anesthesia & Analgesia

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“…The use of spinal opioid analgesia as an adjunct to general anesthesia was .first described by Mathews and Abrams in 1980. '~1 In this report, 40 adults received intrathecal morphine in a dose of 1.5 to 4.0 mg before surgery.…”

Section: Intrathecal (Spinal) Techniquesmentioning

confidence: 99%

The Use of Regional Anesthesia in Combination With General Anesthesia for Cardiac Surgery in Children

Hammer

Wellis

Boltz

et al. 2001

Semin Cardiothorac Vasc Anesth

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The use of regional anesthesia in combination with general anesthesia for children undergoing cardiac surgery is the subject of a growing number of publications and presentations. Benefits of regional anesthesia in patients having cardiac surgery include attenuation of the neuroendocrine response to surgical stress, improved postoperative pulmonary function, enhanced cardiovascular stability, and improved postoperative analgesia. To the extent that regional anesthesia facilitates early tracheal extubation in cardiac surgical patients, complications and costs associated with postoperative mechanical ventilation may be reduced. These benefits must, however, be weighed against the adverse effects that may accompany the use of regional anesthesia, including hypotension, postoperative respiratory depression, and epidural hematoma formation. In this article, the benefits and risks of regional anesthesia in infants and children undergoing open heart surgery are reviewed. In addition, specific spinal and epidural techniques currently in use are described, including management of side effects. Copyright © 2001 by W.B. Saunders Company.R eported benefits of regional anesthesia combined with general anesthesia in patients undergoing cardiac surgery include attenuation of the neuroendocrine response to surgical stress, improved postoperative pulmonary function, enhanced cardiovascular stability, and improved postoperative analgesia. Regional anesthesia may facilitate early tracheal extubation in cardiac surgical patients, reducing the complications and costs associated with postoperative mechanical ventilation. These benefits must, however, be weighed against the adverse effects that may accompany the use of regional anesthesia (hypotension, postoperative respiratory depression, and epidural hematoma formation).The Benefits of Regional Anesthesia in Cardiac Surgery Adverse physiologic responses that occur during and after cardiac surgery include alterations in circulatory (tachycardia, hypertension, vasoconstriction), metabolic (increased catabolism), immunologic (impaired immune response), and hemostatic (platelet activation) systems.1,2 Together, these changes are referred to as the stress response. The stress response associated with cardiac surgery in neonates may be profound and is associated with increased morbidity and mortality.3 Anand et a13 measured such responses during and after cardiac surgery in 15 neonates anesthetized with halothane and morphine. They found elevated plasma concentrations of epinephrine, norepinephrine, cortisol, glucagon, and beta endorphin in all patients, accompanied by hyperglycemia and lactic acidemia. The 4 deaths in the study group occurred in the neonates with the greatest stress responses.Bromage et al4 first showed in 1971 that the stress response associated with major abdominal and thoracic surgery could be attenuated with epidural blockade. Since then, several investigators have shown that the use of regional anesthesia during and after cardiac surgery (ie, intraoperative anes...

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Intrathecal Morphine in Open Heart Surgery

Cited by 89 publications

References 3 publications

Side effects of intrathecal and epidural opioids

Side effects of intrathecal and epidural opioids

Thoracic Epidural Anesthesia During Coronary Artery Bypass Surgery

The Use of Regional Anesthesia in Combination With General Anesthesia for Cardiac Surgery in Children

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