Influence of intrathecal morphine and naloxone intervention on postoperative ventilatory regulation in elderly patients

Thirty elderly patients undergoing major hip surgery under spinal analgesia were randomly allocated in a double‐blind manner into three groups. The aim was to evaluate the influence of intrathecal morphine and postoperative naloxone infusion on the regulation of ventilation. The Bupivacaine Group received spinal analgesia with 20 mg bupivacaine intrathecally. The Morphine Group received spinal analgesia with 20 mg bupivacaine + 0.3 mg morphine intrathecally. The Naloxone Group received spinal analgesia with 20 mg bupivacaine + 0.3 mg morphine intrathecally + postoperative naloxone infusion intravenously (1 μg/kg/h over 12 h, 0.25 μg/kg/h over the next 12 h). Evaluation of resting ventilation and the ventilatory responses to hypercarbia and hypoxaemia was made on three occasions: before surgery, and 8, and 24 h after the intrathecal injection. Intrathecal morphine had no significant effect on ventilatory regulation in elderly patients undergoing major hip surgery performed under bupivacaine spinal analgesia. Postoperative administration of opioids or sedatives after intrathecal morphine as well as postoperative blood loss associated with a fall in blood pressure appeared to increase the risk of developing respiratory depression. Naloxone infusion seemed to reduce the risk of developing respiratory depression. Furthermore, one third of the elderly had a poor response to hypoxaemia before surgery.

[1]  C. Lennmarken,et al.  Attenuated ventilatory response to hypoxaemia at vecuronium‐induced partial neuromuscular block , 1992, Acta anaesthesiologica Scandinavica.

[2]  B. Löfström,et al.  Influence of Local Anesthetics on Ventilation , 1991, Regional Anesthesia & Pain Medicine.

[3]  H. Kehlet,et al.  Late postoperative episodic and constant hypoxaemia and associated ECG abnormalities. , 1990, British journal of anaesthesia.

[4]  A. Johnson,et al.  A new method for studying the ventilatory response in patients , 1990, Acta anaesthesiologica Scandinavica.

[5]  C. Hanning,et al.  EDITORIALS II: POSTOPERATIVE MYOCARDIAL INFARCTION AND EPISODIC HYPOXAEMIA , 1989 .

[6]  J. Schadt.  Sympathetic and hemodynamic adjustments to hemorrhage: a possible role for endogenous opioid peptides. , 1989, Resuscitation.

[7]  H. Kehlet,et al.  Episodic arterial oxygen desaturation and heart rate variations following major abdominal surgery. , 1989, British journal of anaesthesia.

[8]  C. Nixon,et al.  Sedation during spinal anaesthesia: a case for the routine administration of oxygen. , 1989, British journal of anaesthesia.

[9]  R. Stoelting.  Intrathecal morphine--an underused combination for postoperative pain management. , 1989, Anesthesia and analgesia.

[10]  J. Crul,et al.  Oxygen desaturation following sedation for regional analgesia. , 1989, British journal of anaesthesia.

[11]  R. Ward,et al.  Intrathecal methadone and morphine for postoperative analgesia: a comparison of the efficacy, duration, and side effects. , 1988, Anesthesiology.

[12]  B. Gutsche,et al.  Mini-Dose Intrathecal Morphine for the Relief of Post-Cesarean Section Pain: Safety, Efficacy, and Ventilatory Responses to Carbon Dioxide , 1989 .

[13]  C. Hanning,et al.  Postoperative myocardial infarction and episodic hypoxaemia. , 1989, British journal of anaesthesia.

[14]  C. Chabal,et al.  A Dose‐Response Study of Intrathecal Morphine: Efficacy, Duration, Optimal Dose, and Side Effects , 1988, Anesthesia and analgesia.

[15]  A. Johnson,et al.  Influence of Postoperative Naloxone Infusion on Respiration and Pain Relief After Intrathecal Morphine , 1988, Regional Anesthesia & Pain Medicine.

[16]  D. Altman,et al.  Antagonism of morphine-induced respiratory depression with nalmefene. , 1988, British journal of anaesthesia.

[17]  E. Abouleish.  APNOEA ASSOCIATED WITH THE INTRATHECAL ADMINISTRATION OF MORPHINE IN OBSTETRICS , 1988 .

[18]  N. Rawal,et al.  Combined Intrathecal Morphine and Bupivacaine for Cesarean Section , 1987, Anesthesia and Analgesia.

[19]  J. Moore,et al.  Mini‐Dose Intrathecal Morphine for the Relief of Post‐Cesarean SectionPain: Safety, Efficacy, and Ventilatory Responses to Carbon Dioxide , 1988, Anesthesia and analgesia.

[20]  N. Rawal,et al.  Present state of extradural and intrathecal opioid analgesia in Sweden. A nationwide follow-up survey. , 1987, British journal of anaesthesia.

[21]  T. Krantz,et al.  Respiratory depression after intrathecal opioids , 1987, Anaesthesia.

[22]  A. Johnson,et al.  Anesthesia for Major Hip Surgery: A Clinical Study of Spinal and General Anesthesia in 244 Patients , 1986, Regional anesthesia and pain medicine.

[23]  T. Cramond,et al.  Delayed respiratory depression following repeated intrathecal low dose morphine. , 1985 .

[24]  G. Hedenstierna,et al.  Effect of Anaesthesia on Respiratory Function after Major Lower Extremity Surgery A Comparison between Bupivacaine Spinal Analgesia with Low‐Dose Morphine and General Anaesthesia , 1985, Acta anaesthesiologica Scandinavica.

[25]  S. Tsai,et al.  Delayed respiratory depression following repeated intrathecal low dose morphine. , 1985, Anaesthesia and intensive care.

[26]  F. Clergue,et al.  Respiratory Effects of Intrathecal Morphine after Upper Abdominal Surgery , 1984, Anesthesiology.

[27]  Cousins Mj,et al.  Intrathecal and epidural administration of opioids , 1984 .

[28]  J. Kinney,et al.  SPLANCHNIC OXYGEN CONSUMPTION AND SUBSTRATE RALANCE FOLLOWING ACCIDENTAL INJURY , 1984 .

[29]  P. Glass.  Respiratory depression following only 0.4 mg of intrathecal morphine. , 1984, Anesthesiology.

[30]  L. Mather,et al.  Intrathecal and epidural administration of opioids. , 1984, Anesthesiology.

[31]  J. Löfström,et al.  Postoperative Pain Relief with Intrathecal Morphine After Major Hip Surgery , 1983, Regional Anesthesia & Pain Medicine.

[32]  E. Kalso.  Effects of intrathecal morphine, injected with bupivacaine, on pain after orthopaedic surgery. , 1983, British journal of anaesthesia.

[33]  S. Lahiri,et al.  Effects of naloxone on carotid body chemoreception and ventilation in the cat. , 1981, Journal of applied physiology: respiratory, environmental and exercise physiology.

[34]  R. D. Jones,et al.  Intrathecal morphine: naloxone reverses respiratory depression but not analgesia. , 1980, British medical journal.

[35]  M. Barrow.  Postoperative pain control with intrathecal morphine , 1981, Anaesthesia.

[36]  E. Munson,et al.  Neurologic depression after intrathecal morphine. , 1981, Anesthesiology.

[37]  R. D. Jones,et al.  Intrathecal morphine: naloxone reverses respiratory depression but not analgesia. , 1980, British medical journal.

[38]  R E Johnstone,et al.  Reversal of morphine anesthesia with naloxone. , 1974, Anesthesiology.

[39]  R S Kronenberg,et al.  Attenuation of the ventilatory and heart rate responses to hypoxia and hypercapnia with aging in normal men. , 1973, The Journal of clinical investigation.