Lumbar epidural morphine infusions for children undergoing cardiac surgery

Shayevitz, Jay R.; Merkel, Sandra; O'kelly, S.W.; Reynolds, Paul I.; Gutstein, Howard B.

doi:10.1016/s1053-0770(96)80241-2

Cited by 42 publications

(13 citation statements)

References 24 publications

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“…Shoyevitz et al .,[17] Stenseth et al .,[8] and Priestley et al . [16] found a lower VAS and earlier extubation but similar hospital stay with TEA.…”

Section: Discussionmentioning

confidence: 99%

The outcome of thoracic epidural anesthesia in elderly patients undergoing coronary artery bypass graft surgery

El-Morsy

El-Deeb

2012

Saudi J Anaesth

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Background:Thoracic epidural anesthesia (TEA) improves analgesia and outcomes after a cardiac surgery. As aging is a risk factor for postoperative pulmonary complications, TEA is of particular importance in elderly patients undergoing coronary artery bypass graft (CABG).Methods:Fifty patients aged 65–75 years; ASA II and III scheduled for elective CABG were included in the study. Patients were randomized to receive either general anesthesia (GA) group alone or GA combined with TEA group. Heart rate (HR), mean arterial pressure (MAP), and central venous pressure were recorded. Total dose of fentanyl μg/kg, aortic cross clamping, cardiopulmonary bypass (CPB) time, time to first awaking and extubation, arterial blood gases, visual analog scale (VAS) score in intensive care unit were reported. Postoperative pulmonary function tests were done.Results:TEA showed a significant HR and lower MAP compared with the GA group. The total dose of intraoperative fentanyl and nitroglycerine were significantly lower in the TEA. Patients in TEA group have statistically significantly higher PaO2, lower PaCO2, increase in Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV1)Conclusions:TEA reduced severity of postoperative pulmonary function and restoration was faster in TEA group in elderly patients undergoing CABG. Also, it resulted in earlier extubation and awakening, better analgesia, lower VAS.

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“…Shoyevitz et al .,[17] Stenseth et al .,[8] and Priestley et al . [16] found a lower VAS and earlier extubation but similar hospital stay with TEA.…”

Section: Discussionmentioning

confidence: 99%

The outcome of thoracic epidural anesthesia in elderly patients undergoing coronary artery bypass graft surgery

El-Morsy

El-Deeb

2012

Saudi J Anaesth

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“…Overall, the reported incidence of respiratory depression associated with epidural opioids is 0% to 1.9% in adults (Table 3) (1,2,4-19) and 0-25% in children (Table 4) (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). The rates most commonly reported in children are 0.5%-1% (24).…”

Section: Discussionmentioning

confidence: 99%

“…However, when reduced respiratory rate and oxygen saturation are included as criteria, rates of 0.07 %-1.2% are reported in adults (Table 3) (4-6,8,11-14,16). Similarly, pediatric studies of epidural analgesia have used two broad definitions of respiratory depression: 1) clinically significant episodes such as re-intubation, use of naloxone or apnea (20,22,29,30); and 2) definitions that include minor events such as respiratory rate <10 per minute or oxygen saturation < 90% (23,25). One potential criticism of our study is that it did not use age specific respiratory rates, which may be relevant in small children and babies.…”

Section: Discussionmentioning

confidence: 99%

The Safety of Concurrent Administration of Opioids via Epidural and Intravenous Routes for Postoperative Pain in Pediatric Oncology Patients

Anghelescu

Ross

Oakes

et al. 2008

Journal of Pain and Symptom Management

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Supplementation of epidural opioid analgesia with intravenous opioids is usually avoided because of concern about respiratory depression. However, the choice of adjunct analgesic agents for pediatric oncology patients is limited. Antipyretic drugs may mask fever in neutropenic patients, and nonsteroidal anti-inflammatory agents may exert anti-platelet effects and interact with chemotherapeutic agents. We examined the safety of concurrent use of epidural and intravenous opioids in a consecutive series of 117 epidural infusions in pediatric patients and compared our findings to those reported by other investigators. We observed a 0.85% rate of clinically significant respiratory complications. The single adverse event was associated with an error in dosage. In our experience, the supplementation of epidural opioid analgesia with intravenous opioids has been a safe method of postoperative pain control for pediatric patients with cancer.

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“…19 Several other studies in children have shown excellent analgesia and no evidence of respiratory depression when the dose of epidural morphine does not exceed 0.05 mg/kg. [31][32][33] Similarly, doses of intrathecal morphine of 0.02 or 0.03 mg/kg may result in significant respiratory depression after cardiac surgery in children.…”

Section: Respiratory Depressionmentioning

confidence: 94%

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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Lumbar epidural morphine infusions for children undergoing cardiac surgery

Cited by 42 publications

References 24 publications

The outcome of thoracic epidural anesthesia in elderly patients undergoing coronary artery bypass graft surgery

The outcome of thoracic epidural anesthesia in elderly patients undergoing coronary artery bypass graft surgery

The Safety of Concurrent Administration of Opioids via Epidural and Intravenous Routes for Postoperative Pain in Pediatric Oncology Patients

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

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