Intrathecal Morphine Plus General Anesthesia in Cardiac Surgery: Effects on Pulmonary Function, Postoperative Analgesia, and Plasma Morphine Concentration

Santos, Luciana Oliveira dos; Santos, Verônica Cavani Jorge; Santos, Sílvia Regina Cavani Jorge; Malbouisson, Luíz Marcelo Sá; Carmona, Maria José Carvalho

doi:10.1590/s1807-59322009000400003

Cited by 21 publications

(15 citation statements)

References 36 publications

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“…CABG candidate patients remain in a supine position for more than 2 h, and the undesired ventilation mentioned above can lead to more harm and to abnormal pulmonary shunt fraction. Generally, the possible damage to the anaesthetic process in patients involves reduction of vital capacity and the functional residual capacity of the lungs and widened alveolar-arterial oxygen gradient, which ultimately leads to hypoxaemia and atelectasis [18,[43][44][45][46].…”

Section: Anaesthesia Proceduresmentioning

confidence: 99%

Pulmonary complications following cardiac surgery

Mali¹,

Haghaninejad²

2019

Arch Med Sci Atheroscler Dis

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Coronary heart disease is a common diseases of atherosclerosis. Despite the development of noninvasive therapies and the advancement of pharmacological methods and extensive drug regimens, coronary artery bypass grafting surgery is still the ultimate treatment option in many patients. Among the various complications following open heart surgery, one of the common difficulties is pulmonary complications associated with subsequent morbidity and mortality, which should be studied according to preoperative, perioperative, and postoperative factors. Preoperative factors include genetics, age, family history of pulmonary disease, smoking, coexisting disease, etc. Perioperative factors include surgical procedures like sternotomy incision, cardioplegia, and internal mammary artery harvesting; anaesthesia procedure effects like pulmonary collapse, maintenance drugs and morphine administration; and cardiopulmonary bypass pump by systemic inflammatory response syndromes. And finally, postoperative factors, especially mediastinitis and the role of nursing in the intensive care unit. Pulmonary complications after cardiac surgery include atelectasis, pleural effusions, pneumonia, pulmonary oedema, cardiogenic pulmonary oedema, acute respiratory distress syndrome, pulmonary embolism, phrenic nerve injury, pneumothorax, sternal wound infection, and mediastinitis, with different outbreaks in patients reported. Although the preoperative, perioperative, and postoperative factors play an important role in the occurrence of these complications, the preoperative factors, as factors that can be adjusted, should be considered more than the others and explained to the patient, and the preoperative patient's assessment should be noted. Also, postoperative care with the goal of reducing infections and pulmonary complications should be addressed by the nursing team.

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Section: Anaesthesia Proceduresmentioning

confidence: 99%

Pulmonary complications following cardiac surgery

Mali¹,

Haghaninejad²

2019

Arch Med Sci Atheroscler Dis

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“…However, there is no evidence that they improve chronic postoperative pain. [108][109][110][111][112][113][114][115][116][117][118] Parasternal Intercostal and Paravertebral Blocks Parasternal intercostal and paravertebral blocks reduce acute postoperative pain. [119][120][121][122] Despite this, there is no evidence that either has an effect on chronic poststernotomy pain.…”

Section: Transdermal Lidocainementioning

confidence: 99%

Chronic Poststernotomy Pain

Kleiman

Sanders

Nemergut

et al. 2017

Regional Anesthesia and Pain Medicine

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Chronic pain following median sternotomy is common after cardiac surgery. If left untreated, chronic sternal pain can reduce quality of life, affecting sleep, mood, activity level, and overall satisfaction. This has a significant societal effect given the large number of cardiac surgeries annually. Although a number of pathophysiologic processes and risk factors are assumed to contribute, the exact cause and major risk factors remain unknown. Moreover, the treatment of chronic poststernotomy pain is often inadequate, relying on opioids and other medications that provide minimal benefit to the patient and have significant adverse effects. Indeed, little is known regarding the prevention of chronic pain development following sternotomy. This review aims to present the current, limited data regarding the incidence, risk factors, treatment, and prevention of chronic poststernotomy pain and to identify areas of future research to improve management of this common complaint following cardiac surgery.

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“…Previous studies have demonstrated the positive effects of high doses of intrathecal morphine on analgesia and respiratory function. [3,4] Jacobson showed that early extubation was possible with a dosage of 6 µg·kg -1 morphine. [5] The minimal effective dose of intrathecal morphine in cardiac surgery still remains unclear.…”

mentioning

confidence: 99%

Intrathecal morphine is superior to intravenous PCA in patients undergoing minimally invasive cardiac surgery

et al. 2012

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Aim of our study was to evaluate the beneficial effect of low dose intrathecal morphine on postoperative analgesia, over the use of intravenous patient controlled anesthesia (PCA), in patients undergoing fast track anesthesia during minimally invasive cardiac surgical procedures. A randomized controlled trial was undertaken after approval from local ethical committee. Written informed consent was obtained from 61 patients receiving mitral or tricuspid or both surgical valve repair in minimal invasive technique. Patients were assigned randomly to 2 groups. Group 1 received general anesthesia and intravenous patient controlled analgesia (PCA) pump with Piritramide (GA group). Group 2 received a single shot of intrathecal morphine (1.5 μg/kg body weight) prior to the administration of general anesthesia (ITM group). Site of puncture was confined to lumbar (L1-2 or L2-3) intrathecal space. The amount of intravenous piritramide used in post anesthesia care unit (PACU) and the first postoperative day was defined as primary end point. Secondary end points included: time for tracheal extubation, pain and sedation scores in PACU upto third postoperative day. For statistical analysis Mann-Whitney-U Test and Fishers exact test (SPSS) were used. We found that the demand for intravenous opioids in PACU was significantly reduced in ITM group (P <0.001). Pain scores were significantly decreased in ITM group until second postoperative day (P <0.01). There was no time delay for tracheal extubation in ITM group, and sedation scores did not differ in either group. We conclude that low dose single shot intrathecal morphine provides adequate postoperative analgesia, reduces the intravenous opioid consumption during the early postoperative period and does not defer early extubation.

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Intrathecal Morphine Plus General Anesthesia in Cardiac Surgery: Effects on Pulmonary Function, Postoperative Analgesia, and Plasma Morphine Concentration

Cited by 21 publications

References 36 publications

Pulmonary complications following cardiac surgery

Pulmonary complications following cardiac surgery

Chronic Poststernotomy Pain

Intrathecal morphine is superior to intravenous PCA in patients undergoing minimally invasive cardiac surgery

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