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Cardiothoracic Anesthesia, Respiration and Airway

Low-dose intrathecal morphine does not delay early extubation after cardiac surgery

  • Eric Jacobsohn 
  • Trevorx W. R Lee
  • Ryan J Amadeo
  • Paul H Syslak
  • Roland G Debrouwere
  • Dean Bell
  • P. Alan Klock
  • Heidi Tymkew
  • Michael Avidan
Article

Abstract

Purpose

This study was designed to examine the efficacy of low-dose intrathecal morphine (ITM) on extubation times and pain control after cardiac surgery.

Methods

43 patients undergoing elective cardiac surgery were enrolled in this prospective, randomized, double-blind placebo controlled trial. Patients were given a pre-induction dose of ITM (6 μg·kg-1 per ideal body weight in 5 mL normal saline, group ITM) or 5 mL of intrathecal normal saline (group ITS). Anesthesia was induced with thiopental (3 mgkg-1), sufentanil, midazolam and rocuronium. The total allowable doses of sufentanil and midazolam for the entire case were limited to 0.5 μg·kg-1 and 0.045 mg·kg-1 respectively. Anesthesia was maintained with isoflurane before and during cardiopulmonary bypass (CPB), and with propofol after CPB. In the postanesthesia care unit, patients received nurse-administered morphine followed by patient-controlled analgesia morphine. Serial visual analogue scale pain scores, morphine use, mini-mental state examinations and pulmonary function tests were measured for 48 hr. Patient satisfaction questionnaires were completed at the time of discharge.

Results

Mean times to extubation from the application of dressings were short and did not differ between groups (ITM = 41.4 ± 33.0 min, ITS = 39.2 ± 37.1 min). During the first 24 hr postoperatively, the ITM group had improved pain control and a lower iv morphine requirement than the control group, both at rest and during deep breathing. Both forced expiratory volume in one second and forced vital capacity were improved in the ITM group. There were no differences in spinal-related side effects or in the overall complication rates. Patient satisfaction was high in both groups.

Conclusion

Low-dose ITM for cardiac surgery did not delay early extubation, but it improved postoperative analgesia and pulmonary function.

Keywords

Morphine Sufentanil Rocuronium Visual Analogue Scale Pain Score Intrathecal Morphine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Ľadministration intrathécale ďune faible dose de morphine ne retarde pas ľextubation précoce après une intervention chirurgicale cardiaque

Résumé

Objectif

Vérifier ľefficacité ďune faible dose de morphine intrathécale (MIT) sur le temps ďextubation précoce et le contrôle de la douleur après une opération en cardiochirurgie.

Méthode

Ľétude prospective, randomisée et à double insu contre placebo a été menée auprès de 43 patients de cardiochirurgie élective. Les patients ont reÇu une dose de MIT avant ľinduction (6 μg·kg-1 par poids corporel idéal dans 5 mL de solution salée, groupe MIT) ou 5 mL de solution salée intrathécale (groupe SIT). Ľanesthésie a été induite avec du thiopental (3 mg·kg-1), du sufentanil, du midazolam et du rocuronium. Les doses totales permises de sufentanil et de midazolam pour toute ľopération ont été respectivement limitées à 0,5 μg·kg-1 et à 0,045 mg·kg-1. Ľanesthésie a été maintenue avec de ľisoflurane avant et pendant la circulation extracorporelle (CEC), et avec du propofol après la CEC. À la salle de réveil, les patients ont reÇu de la morphine administrée par une infirmière, puis par injection auto-contrôlée. Les séries de scores de douleur de ľéchelle visuelle analogique, la consommation de morphine, les mini-examens de ľétat mental et ľexploration respiratoire fonctionnelle ont été mesurés pendant 48 h. Des questionnaires sur la satisfaction des patients ont été remplis au moment du départ.

Résultats

Le temps moyen écoulé entre ľapplication de pansement et ľextubation a été court et comparable ďun groupe à ľautre (MIT = 41,4 ± 33,0 min, SIT = 39,2 ± 37,1 min). Pendant les 24 premières heures après ľopération, les patients du groupe MIT ont été mieux soulagés de leurs douleurs et ont utilisé moins de morphine iv que ceux du groupe témoin, et ce, au repos et pendant la respiration profonde. Le volume expiratoire maximum par seconde et la capacité vitale forcée ont été améliorés dans le groupe MIT. Il n’y avait pas de différence intergroupe entre les complications liées à ľinjection rachidienne ou les autres complications en général. La satisfaction des patients a été élevée dans les deux groupes. Conclusion : Une faible dose de MIT ne retarde pas ľextubation précoce et améliore ľanalgésie postopératoire et la fonction pulmonaire après une opération en cardiochirurgie.

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Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  • Eric Jacobsohn 
    • 1
  • Trevorx W. R Lee
    • 2
  • Ryan J Amadeo
    • 2
  • Paul H Syslak
    • 3
  • Roland G Debrouwere
    • 2
  • Dean Bell
    • 2
  • P. Alan Klock
    • 4
  • Heidi Tymkew
    • 1
  • Michael Avidan
    • 1
  1. 1.Departments of Anesthesiology and SurgeryWashington University School of MedicineSt. LouisUSA
  2. 2.Departments of AnesthesiaUniversity of ManitobaWinnipegCanada
  3. 3.Departments of AnesthesiaVictoria HospitalWinnipegCanada
  4. 4.Departments of Anesthesiology and SurgeryUniversity of ChicagoChicagoUSA

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