Epidural morphine reduces halothane MAC in humans

Schwieger, Ian M.; Klopfenstein, Claude-Eric; Forster, A.

doi:10.1007/bf03008338

Cited by 16 publications

(8 citation statements)

References 23 publications

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“…It has been reported that intravenous or intrathecal morphine is able to reduce the minimum alveolar concentration of halothane [8][9][10] . In the present study, the fact that naloxone blocked the sevoflurane-induced inhibition of nociceptive C responses provides further support for the involvement of spinal opioid receptors in antinociception mediated by sevoflurane.…”

Section: Discussionmentioning

confidence: 99%

“…For example, a common property of a wide spectrum of general anesthetics, including barbiturates and propofol, is enhancement of the action of GABA A receptors [1][2][3][4] . Increasing evidence have indicated that the spinal cord is pivotal in the immobility induced by volatile anesthetics because the anesthetics depress the activity of α-motoneurons in the spinal cord [5,6] , in which process spinal GABA receptors and opioid peptide receptors may be involved [7][8][9][10] . However, there has been few study on the effects of sevoflurane on pain processing in the spinal cord.…”

Section: Introductionmentioning

confidence: 99%

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Involvement of GABA and opioid peptide receptors in sevoflurane-induced antinociception in rat spinal cord

Wang

Deng

You

et al. 2005

Acta Pharmacologica Sinica

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Aim: The spinal cord is pivotal in immobility induced by volatile anesthetics because the anesthetics depress the activity of motor neurons in the spinal cord. The aim of this study was to observe the effects of sevoflurane on pain processing at the spinal level. Methods: The firing of the gastrocnemius muscle was evoked by electrical stimulation to the ipsilateral hindpaw in rats. The nociceptive C response of electromyography (EMG) was selected to study. The GABAA receptor antagonist bicuculline (0.1 mg/kg) and opioid receptor antagonist naloxone (0.4 mg/kg) were administered intravenously, either in the presence or in the absence of 1.0% sevoflurane. Results: In rats with transected spinal cord, sevoflurane produced a profound reduction in the C response in a dose‐ and time‐dependent manner. In the presence of 1.0% sevoflurane, the C responses were increased after injections of bicuculline and naloxone. Conclusion: Sevoflurane is a volatile anesthetic that acts directly on the spinal cord to suppress the nociceptive reflex. The sevoflurane‐induced suppression of the C response is antagonized by either bicuculline or naloxone. The results suggest that spinal GABAA receptors and opioid peptide receptors are involved in the sevoflurane‐induced suppression of spinal nociception.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Involvement of GABA and opioid peptide receptors in sevoflurane-induced antinociception in rat spinal cord

Wang

Deng

You

et al. 2005

Acta Pharmacologica Sinica

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“…For example, epidural morphine reduced halothane MAC by at least 33% in dogs (Valverde et al 1989) and 14% in ponies (Doherty et al 1997). In humans, it is reported that epidural morphine reduces the halothane MAC by 28% (Schwieger et al 1992) and isoflurane MAC by 14% (Kashyap et al 2003). However, neither epidural morphine nor buprenorphine MAC sparing effects have been described in pigs according to the cited references.…”

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confidence: 99%

Changes in minimal alveolar concentration of isoflurane following treatment with medetomidine and tiletamine/zolazepam, epidural morphine or systemic buprenorphine in pigs

et al. 2008

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SummaryThe aim of this study was to determine the changes in minimal alveolar concentration (MAC) of isoflurane after treatment with medetomidine and tiletamine/zolazepam (MTZ), epidural morphine or systemic buprenorphine in 11 healthy crossbred pigs. The first part of this study was to measure the baseline values in pigs induced with isoflurane (5%) by face mask and maintained with isoflurane in air and oxygen for 2 h (ISO). Baseline isoflurane MAC was determined using mechanical stimulation. Thereafter, each pig was randomly chosen for a crossover test in which the same animal received three different treatments with at least one week in between treatments. The three treatments were as follows: induction of anaesthesia with medetomidine (0.05 mg kg 21) and tiletamine/zolazepam (2.5 mg kg 21 each) given intramuscularly (MTZ); MTZ followed by epidural morphine (0.1 mg kg 21 ; MTZ/M); and MTZ followed by intramuscular buprenorphine (0.1 mg kg 21; MTZ/B). All pigs were maintained with isoflurane in oxygen and air for 2 h and their lungs were mechanically ventilated. The end-tidal isoflurane concentration, respiratory rate, inspiratory and expiratory O 2 and CO 2 concentrations, heart rate (HR) and arterial blood pressure were recorded every 10 min. Arterial blood gases were analysed every 20 min. Among the treatment groups, differences in isoflurane MAC were tested using GLM and Tukey's method for further comparison; P , 0.05 was adopted as significant. Isoflurane MAC was 1.9 + 0.3%. MTZ reduced isoflurane MAC to 0.6 + 0.1%. Additional morphine or buprenorphine reduced the MTZ isoflurane MAC further to 0.4 + 0.2 and 0.3 + 0.1%, respectively. During MTZ, MTZ/M and MTZ/B mean arterial blood pressure was higher and the alveolar-arterial oxygen tension difference was lower compared with ISO. In conclusion, induction of anaesthesia with MTZ reduced the isoflurane MAC in pigs by 68%. Additional epidural morphine or systemic buprenorphine decreased MTZ isoflurane MAC by 33 and 50%, respectively.

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“…[5] Epidural morphine reduces the MAC of halothane by 28% and isoflurane by 14%. [10,11] Strum et al had supplemented general anaesthesia with epidural analgesia for open surgical procedures in morbidly obese patients. [6] But he administered age adjusted 1 MAC end-tidal concentrations of inhalational agents (desflurane/sevoflurane) and did not account for the MAC sparing effect of epidural local anaesthetics and opioids.…”

Section: Discussionmentioning

confidence: 99%

Emergence and Recovery Characteristics After Low Flow Anaesthesia With Desflurane and Sevoflurane in Cancer Patients Administered Combined Epidural and General Anaesthesia

Srivastava¹,

Chowdhury²,

Bhargava³

2017

Ann. Int. Med. Den.Res.

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Epidural morphine reduces halothane MAC in humans

Cited by 16 publications

References 23 publications

Involvement of GABA and opioid peptide receptors in sevoflurane-induced antinociception in rat spinal cord

Involvement of GABA and opioid peptide receptors in sevoflurane-induced antinociception in rat spinal cord

Changes in minimal alveolar concentration of isoflurane following treatment with medetomidine and tiletamine/zolazepam, epidural morphine or systemic buprenorphine in pigs

Emergence and Recovery Characteristics After Low Flow Anaesthesia With Desflurane and Sevoflurane in Cancer Patients Administered Combined Epidural and General Anaesthesia

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