Surdosage accidentel en morphine intrarachidienne. Traitement par naloxone intraveineuse seule

Perrot, G.; Muller, Antoine; Laugner, B.

doi:10.1016/s0750-7658(83)80059-8

Cited by 12 publications

(3 citation statements)

References 8 publications

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“…The criterium of hypoxemia was reported in our case after 4000 mcg morphine and six other cases appeared “centrally cyanotic” after 10,000–15,000 mcg morphine [ 18 , 25 , 26 ]. A respiratory rate <4 breaths per minute was reported in 7 cases after 3000–15,000 mcg morphine [ 18 , 23 , 27 , 28 ] and in one patient with a Cheyne-Stokes breathing pattern after 100 mcg morphine [ 24 ]. The remaining cases met the criterium of a pCO2 > 8 kPa.…”

Section: Resultsmentioning

confidence: 99%

“…None of these cases resulted in a fatality. These cases were all after >900 mcg of morphine [ 18 , 23 , 25 – 28 , 38 – 40 ] or after low dose of morphine with coadministration of potentiating medication [ 21 , 24 , 29 , 30 ]. The latter consisted of one case of 100 mcg of self-diluted, intrathecal morphine and 3 mg of IV midazolam, in which flumazenil resolved the respiratory depression [ 21 ], one case in which 400 mcg of intrathecal morphine and 4 mg of IV lorazepam resulted in a pCO2 of 8.5 kPa which resolved spontaneously [ 29 ], one case with concomitant continuous IV fentanyl [ 30 ], and one case in which 100 mcg of intrathecal morphine combined with intravenous metoclopramide and granisetron resulted in a Cheyne-Stokes breathing pattern (CSBP) [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…None of these cases resulted in a fatality. ese cases were all after >900 mcg of morphine [18,23,[25][26][27][28][38][39][40] or after low dose of morphine with coadministration of potentiating medication [21,24,29,30].…”

Section: Discussionmentioning

confidence: 99%

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Serious Adverse Events after a Single Shot of Intrathecal Morphine: A Case Series and Systematic Review

Koning

Reussien

Vermeulen

et al. 2022

Pain Research and Management

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Background. The dose of intrathecal morphine is important because of its narrow therapeutic range. Due to a compounding error, pharmacy-compounded, ready-to-use syringes contained 1 mg ml−1 morphine instead of the intended 50 mcg ml−1. Six patients consequently received this twenty-fold dose. This study aims to describe the serious adverse events in these six patients and a systematic review is added to describe the characteristics of serious adverse events after intrathecal morphine. Methods. A retrospective case series described all six patients that received the erroneous morphine intrathecally for analgesia after laparoscopic segmental colonic resections. The patients’ charts were reviewed for the occurrence, timing, duration and management of adverse events, the vital signs at the night after surgery, and length of hospital stay. A systematic review investigated characteristics of serious adverse events after intrathecal morphine in a perioperative setting. Results. Four patients had a serious adverse event, which was respiratory depression combined with somnolence (n = 3) and hypotension (n = 1). The review yielded 63 cases with serious adverse events, predominantly somnolence and/or respiratory depression. The onset occurred between 2 and 24 hours after injection. The severity of symptoms varied and life-threatening respiratory depression only occurred after a dose >900 mcg or when potentiating medication was used. Naloxone did not affect analgesia. No prolonged sequalae occurred. Conclusion. This study reveals that respiratory depression and somnolence are the predominant serious adverse events after intrathecal morphine in a perioperative setting and demonstrated a large variation in the presentation of symptoms.

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