The Dose Response of Caudal Morphine in Children Undergoing Open Heart Surgery

Carr, Alison; Holthy, H. M.; Hartley, E. J.; Cox, P.; Macpherson, B. A.

doi:10.1097/00000542-199409001-01348

Cited by 3 publications

(3 citation statements)

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“…We reviewed the bibliographies of these articles and included another article for consideration. 5 From these 21 articles, we excluded 5: 2 conference abstracts 6,7 without published manuscripts, 1 commentary, 8 and 2 reviews. 2,5 A gray literature search found one additional article, 9 which was included for a total of 17 articles.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Caudal Anesthesia and Postoperative Outcomes in Pediatric Cardiac Surgery Patients

Maharramova

Taylor

2018

Semin Cardiothorac Vasc Anesth

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Objectives. In pediatric cardiac surgery, does caudal anesthesia promote early extubation, reduce pain scores, reduce stress responses, and length of stay (LOS)? Design. A systematic review. Participants. Inclusion criteria included cardiac surgical procedures (with or without cardiopulmonary bypass) in any subject between the ages of full-term newborn and 18 years receiving caudal anesthesia of any medication combination. Searches were conducted with assistance of an Academic librarian from 1947 to July 2017. Methods. Relevant studies selected were randomized trials or cohort studies. Results. The total number of patients was 2159 in 17 studies. There were 8 prospective randomized clinical trials and 9 cohort studies. Caudal medications included dexmedetomidine, bupivacaine, sufentanil, morphine, fentanyl, and neostigmine. Nine studies reported earlier extubation in patients with caudal anesthesia. Cardiopulmonary bypass and surgical duration mitigated early extubation anesthetic strategies. Three of 5 studies showed reduced pain scores and need for opiates, 2 studies showed no difference. Two of 3 studies showed a reduction in stress response. Hemodynamic assessments were improved in 2 studies and unchanged in 3 studies. Four studies showed reduced hospital LOS. Studies are difficult to interpret because of the comparative techniques used. Conclusions. The data quality in this review is too poor to make recommendations regarding incorporation of caudal anesthesia into clinical practice. Caudal anesthesia may be favorable for early extubation, improved pain, and hemodynamics and reduced LOS. There are many other anesthetic alternatives to facilitate early extubation. Our review is limited by heterogeneous populations, variable pain measurement scales, and absent definitions of extubation indicators.

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Section: Resultsmentioning

confidence: 99%

A Systematic Review of Caudal Anesthesia and Postoperative Outcomes in Pediatric Cardiac Surgery Patients

Maharramova

Taylor

2018

Semin Cardiothorac Vasc Anesth

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“…The use of opium has been documented as far back as 3000 B.C., to the Sumerians, who lived in the Mesopotamian region now a part of southern Iraq. 1 Most people are familiar with compounds such as morphine and heroin (3), as well as some of the morphine antagonists such as naltrexone (4) and naloxone (5), see Figure 1. The legal medicinal use of morphine in the U.S. exceeds 80,000 kg/year, and the world-wide illicit market for narcotics is estimated at more than $760 billion -a sum exceeding the combined GNP of all but a few economies on the planet.…”

Section: Introductionmentioning

confidence: 99%

“…Political unrest or ecological disasters could jeopardize the availability of morphine for medical use, which is important as an analgesic and as an anesthetic. 2,3 Several reviews have been published on the total synthesis of morphine alkaloids; 4 our own most recent update appeared in 2000. 4d Since then at least three total syntheses and several approaches have appeared attesting to the undiminished interest of synthetic chemists in this fascinating molecule.…”

Section: Introductionmentioning

confidence: 99%