Effect of subarachnoid morphine administration on extubation time after coronary artery bypass graft surgery

Alhashemi, Jamal A.; Sharpe, Michael D.; Harris, Chad; Sherman, Vadim; Boyd, Douglas

doi:10.1053/jcan.2000.18300

Cited by 53 publications

(39 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Concerns have been raised regarding the potential for ventilatory depression and delayed extubation when IT morphine is used as part of a fasttracking program, especially with the concomitant use of iv analgesics and sedatives. 8,18,19 IT sufentanil is known to provide an intense and fast-onset analgesia. 8,9 We postulated that the combination of IT mor- phine and sufentanil could avoid deleterious effects and increase patient comfort because of their different peaks of activity.…”

Section: Extubation Postoperative Analgesia and Complicationsmentioning

confidence: 99%

“…23 None of the previous reports of the use of IT morphine for cardiac surgery have indicated the development of subarachnoid or epidural hematoma. 7,19,24 However, usual precautions should be followed to decrease this risk. 24 Our exclusion criteria with respect to this potential complication were particularly strict, and we were ready, in agreement with the surgeons, to delay surgery in case of a bloody tap (which did not occur).…”

Section: Risk Of It Analgesiamentioning

confidence: 99%

See 1 more Smart Citation

Intrathecal sufentanil-morphine shortens the duration of intubation and improves analgesia in fasttrack cardiac surgery

Béttex

Schmidlin

Chassot

et al. 2002

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

P Pu ur rp po os se e: : To compare the effect of combined intrathecal morphine and sufentanil with low-dose iv sufentanil during propofol anesthesia for fast-track cardiac surgery.M Me et th ho od ds s: : Twenty-four consecutive patients with normal cardiopulmonary function who were scheduled for elective cardiac surgery were randomized to receive either a continuous iv infusion of sufentanil 0.9 to 1.8 µg·kg -1 ·min -1 (13 patients), or a single lumbar intrathecal dose of sufentanil 50 µg and morphine 500 µg (11 patients). We prospectively studied perioperative analgesia, time to extubation and early postoperative maximal inspiratory capacity in the two groups. In the intensive care unit, the medical and nursing staff were blinded to the analgesic technique.R Re es su ul lt ts s: : Intrathecal sufentanil morphine allowed a shorter duration of intubation (104 ± 56.5 min vs 213 ± 104 min; P = 0.01), reduced the need for postoperative analgesia with nicomorphine (equipotent to morphine) (0.7 ± 0.4 mg·hr -1 vs 1.2 ± 0.4 mg·hr -1 ; P = 0.008) and improved postoperative maximal inspiratory capacity (53.4 ± 16.1 vs 38.4 ± 12.5% of the norm; P = 0.05).C Co on nc cl lu us si io on n: : In low-risk patients undergoing coronary artery bypass graft or valve surgery, combined intrathecal sufentanil and morphine with a target-controlled infusion of propofol satisfies the goals of fast-track cardiac surgery. (0,7 ± 0,4 mg·h -1 vs 1,2 ± 0,4 mg·h -1 ; P = 0,008) et une amélioration de la capacité inspiratoire maximale postopératoire (53,4 ± 16,1 vs 38,4 ± 12,5 % de la norme ; P = 0,05 AST-TRACK cardiac surgery entails early postoperative extubation with intense control of pain and rapid transfer to the ward and is mostly applied to patients who have well-preserved pulmonary and ventricular function. C Ca ar rd di io ot th ho or ra ac ci ic c A An ne es st th he es si ia a, , R Re es sp pi ir ra at ti io on n a an nd d A Ai ir rw wa ay y

show abstract

Section: Extubation Postoperative Analgesia and Complicationsmentioning

confidence: 99%

Section: Risk Of It Analgesiamentioning

confidence: 99%

Intrathecal sufentanil-morphine shortens the duration of intubation and improves analgesia in fasttrack cardiac surgery

Béttex

Schmidlin

Chassot

et al. 2002

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…A prospective randomized doubleblind study comparing placebo, 250 µg and 500 µg of ITM in 50 patients demonstrated decreased postoperative morphine requirements in the intrathecal group but no differences in extubation time. 9 In a prospective, randomized, double-blind study of 40 patients comparing placebo to 10 µg·kg -1 of ITM, no benefit was reported for postoperative morphine requirements or time to extubation. 4 In addition to the higher ITM dose used in that study, patients received intraoperative iv fentanyl, 10 µg·kg -1 .…”

mentioning

confidence: 97%

“…8 There are reports of the use of lower doses of ITM (250 µg or 500 µg) as part of a fast-track approach in cardiac surgery, with no effect on extubation time (six to seven hours). 9 The current study was designed as a retrospective, comparative, continuous quality improvement audit. This study aimed to establish 1) the success rate for early extubation using our multimodal analgesic approach; and 2) whether the inclusion of low dose ITM (< 5 µg·kg -1 ) further affected extubation times or opioid requirements in the early postoperative period.…”

mentioning

confidence: 99%

“…In our study the mean dose was 259 ± 53 µg. Alhashemi et al 9 concluded that 250 µg was the optimal dose to reduce postoperative morphine requirements without delaying extubation, while Chaney et al 5 used 10 µg·kg -1 of ITM without benefit. Dose finding studies in gynecology 20 and orthopedics 8 suggest 300 µg of ITM to be efficacious and safe, while Palmer 6 showed 100 µg to be effective for analgesia after Cesarean section.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Low dose intrathecal morphine facilitates early extubation after cardiac surgery: results of a retrospective continuous quality improvement audit

Parlow

Steele

O’Reilly

2005

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

P Pu ur rp po os se e: : To document one centre's experience with a multimodal analgesic approach, with or without low dose intrathecal morphine (ITM), in facilitating "fast-track" recovery in patients undergoing cardiac surgery.M Me et th ho od ds s: : Records of 131 consecutive patients who underwent first time elective cardiac surgery during a four-month period in 2000 were reviewed. Patients were divided into two groups: those receiving and those not receiving preoperative low dose ITM (< 5 µg·kg -1 ) as part of a multimodal analgesic technique. Demographic and surgical characteristics, postoperative morphine use, time to extubation and requirement for antiemetics were recorded. R Re es su ul lt ts s: : Overall, 75% of patients were extubated within two hours, and 93% within six hours. Fifty-five patients received, and 76 did not receive, ITM (mean ± SD 259 ± 53 µg) along with a multimodal analgesic technique (parasternal infiltration, acetaminophen and indomethacin, and postoperative iv morphine). Anesthetic technique involved modest dose opioids, volatile agent and propofol infusion. The groups were similar with respect to preoperative, intraoperative and anesthetic characteristics.Mean extubation time for fast-track patients receiving vs not receiving ITM was 75 ± 65 vs 117 ± 85 min (P = 0.003). Intravenous morphine use for the first 12 hr after surgery was also reduced in the ITM group (4.6 ± 4.1 vs 10.0 ± 14.8 mg, P = 0.009). There was no difference in rescue antiemetic or antipruritic requirements, failed fast-tracking, or serious adverse events.C Co on nc cl lu us si io on ns s: : Multimodal postoperative analgesia allowed for uneventful early extubation and low opioid requirements. Low dose ITM further facilitated early extubation, and reduced postoperative analgesic requirements. MIT (4,6 ± 4,1 vs 10,0 ± 14,8 mg, P = 0,009

show abstract

Regional analgesia and ultra-fast-track cardiac anesthesia

Cheng

2005

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Effect of subarachnoid morphine administration on extubation time after coronary artery bypass graft surgery

Cited by 53 publications

References 19 publications

Intrathecal sufentanil-morphine shortens the duration of intubation and improves analgesia in fasttrack cardiac surgery

Intrathecal sufentanil-morphine shortens the duration of intubation and improves analgesia in fasttrack cardiac surgery

Low dose intrathecal morphine facilitates early extubation after cardiac surgery: results of a retrospective continuous quality improvement audit

Regional analgesia and ultra-fast-track cardiac anesthesia

Contact Info

Product

Resources

About