A postoperative patient injected with epidural morphine, 60 mg, developed transient left bundle branch block and somnolence, The overdose was effectively treated with a continuous naloxone infusion for 19 hours, Analgesia persisted for an additional 19.5 hours. There was no evidence of sympathetic blockade or narcotic related neurotoxicity.KEY WORDS: ANALGESIA, epidural morphine; COMPLICATIONS, epidural morphine overdose, EPIDURAL MORPHINE appears to be an effective analgesic for most patients suffering from acute or chronic pain. It is especially appealing for patients with both compromised pulmonary function and a history of alcohol abuse and hepatic cirrhosis. In one such patient, however, we encountered a massive overdose and some unusual after effects from previously unreported complication.
CASE REPORTA 58-year-old man underwent a right upper pulmonary lobectomy for a malignant nodule. Past medical history included an uncomplicated myocardial infarction 13 years earlier, chronic alcoholism until six months previously, and smoking in excess of "60 pack years. Preoperatively the patient chose the epidural administration of morphine for postoperative pain relief through a catheter that would be placed during operation at Tll-Ti2 using the "loss of resistance" method. Preoperative medication consisted of morphine sulphate 5 mg and droperidol 5 mg intravenously. General anaesthesia was induced and maintained with enflurane, nitrous oxide and oxygen for three hours. When the patient had been extubated and awake for 45 minutes and complained of severe incisional pain, chloroprocaine three per cent (1 ml) was injected to rule our intrathecal catheter placement. Three minutes later, a solution labelled as morphine sulphate 6 mg in distilled water (15 rrd) was injected into the epidural space. Fifteen minutes after epidural injection, the psychogalvanic skin reflex (PGR) was tested and found intact. Thirty minutes after the epidural injection, the anaesthetist (PJM) was summoned because the modified Vs lead on the electrocardiogram (EKG) monitor showed
About twenty years ago my associates and I published one ofthe first papers on the use of succinyl choline in electroshock therapy (‘Report on the Use of Succinyl Choline Dichloride in Electroconvulsive Therapy', American Journal of Psychiatry, iou, No. i 2, June 1953).Since that time, there appears to have been relatively little advance in electroshock therapy.For years we have noticed that some patients who make little if any response to shock treatment
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