Hypothermia and excessive sweating following intrathecal morphine in a parturient undergoing cesarean delivery

Sayyid, Sahar S.; Jabbour, Dima G.; Baraka, Anis

doi:10.1053/rapm.2003.50043

Cited by 18 publications

(14 citation statements)

References 17 publications

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“…Persistent hypothermia after spinal anesthesia with intrathecal morphine has been described in six other case reports of 20 patients (Table), [5][6][7][8][9]11 and another case has been described in a non-obstetrical patient. 11 All of the patients reported nausea and diaphoresis; a number of them complained of feeling hot, and none of them shivered or felt cold.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 While hypothermia can be a common consequence of spinal anesthesia due to vasodilatation and the loss of the shivering reflex, 4 several anecdotal reports describe persistent hypothermia in the obstetrical population after spinal anesthesia using intrathecal morphine. [5][6][7][8][9] This case report describes persistent hypothermia following spinal anesthesia using intrathecal morphine for total knee arthroplasty and the return to normothermia after sublingual lorazepam.…”

Section: Résumémentioning

confidence: 99%

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Persistent hypothermia after intrathecal morphine: case report and literature review

Ryan

Price

Warriner

et al. 2011

Can J Anesth/J Can Anesth

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Purpose To describe a case of persistent hypothermia following spinal anesthesia with intrathecal morphine. Clinical features Following elective right total knee arthroplasty under spinal anesthesia with isobaric 0.5% bupivacaine 11 mg, fentanyl 15 lg, and preservative-free morphine 150 lg, a 57-yr-old female (93.5 kg, 151 cm) developed postoperative hypothermia with a nadir rectal temperature of 33.6°C four hours after surgery. At times, her temperature could not be measured by tympanic, temporal arterial, oral, axillary, or rectal routes. In spite of the low temperature, the patient complained of feeling hot and was diaphoretic without shivering. With the exception of her temperature, her vital signs were normal postoperatively, and aside from hyperglycemia, complete blood count, electrolytes, thyroid-stimulating hormone, serum cortisol, troponin, and twelve-lead electrocardiogram were normal. Her temperature did not respond to warming efforts with a forced-air warming blanket, infusion of warmed intravenous crystalloid, and hourly bladder irrigation with warm saline through an indwelling urinary catheter. Normothermia returned after she received a small dose of sublingual lorazepam eight hours after surgery. The remainder of her postoperative stay was uneventful. Conclusion Patients undergoing spinal anesthesia with intrathecal morphine may develop postoperative hypothermia that is resistant to warming measures. This complication may be treated successfully with lorazepam. RésuméObjectif De´crire un cas d'hypothermie persistante apre`s anesthe´sie me´dullaire avec administration intrathe´cale de morphine. Caractéristiques cliniques Apre`s arthroplastie totale programme´e du genou droit sous anesthe´sie me´dullaire utilisant de la bupivacaı¨ne 0,5 % isobare 11 mg, du fentanyl 15 lg et de la morphine 150 lg sans agent de conservation, une femme aˆge´e de 57 ans (93,5 kg, 151 cm) a pre´sente´une hypothermie postope´ratoire avec une tempe´rature rectale descendant jusqu'a`33,6°C quatre heures apre`s l'ope´ration. Par moment, sa tempe´rature n'a pas pu eˆtre mesure´e par voie tympanique, orale, axillaire, ou rectale, ou par le biais de l'arte`re temporale. En de´pit de cette tempe´rature basse, la patiente s'est plainte d'une sensation de chaleur et pre´sentait une diaphore`se sans frissonnement. A`l'exception de sa tempe´rature, ses signes vitaux postope´ratoires e´taient normaux et hormis une hyperglyce´mie, la formule sanguine comple`te, les e´lectrolytes, l'hormone thyre´otrope, le cortisol se´rique, la troponine et un e´lectrocardiogramme a`12 de´rivations e´taient normaux. Sa tempe´rature n'a pas re´agi aux efforts de re´chauffement avec une couverture chauffante aÀ uthor contributions Kenneth Ryan conducted the literature review, wrote the first draft of the case report, and contributed to the revisions of the manuscript. James Price was involved in the care of the patient and contributed extensively to the revisions of the manuscript. Brian Warriner was involved in the care of the patient and contr...

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Section: Discussionmentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

Persistent hypothermia after intrathecal morphine: case report and literature review

Ryan

Price

Warriner

et al. 2011

Can J Anesth/J Can Anesth

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“…It is not known whether such a small dose of morphine also intensifies the hypothermic action associated with spinal anaesthesia. There is a single case report by Sayyid et al [4] describing a case of intra-operative hypothermia with intrathecal morphine (200 lg). Wishaw also reported hypothermia after subarachnoid injection of 250 lg morphine in a 31-year-old woman undergoing caesarean section [5].…”

Section: Discussionmentioning

confidence: 99%

“…Severe hypothermia has been reported when a large dose of morphine was used in spinal anaesthesia [3]. Although hypothermia associated with smaller doses of morphine has been reported sporadically [4,5], it is not known whether a very small dose of morphine (150 lg) would also intensify spinal anaesthesia-induced hypothermia. This randomised double-blind controlled study was performed to evaluate the effect of adding 150 lg of morphine to bupivacaine on body temperature in parturients during elective caesarean section under spinal anaesthesia.…”

mentioning

confidence: 99%

A randomised double‐blind controlled study evaluating the hypothermic effect of 150 μg morphine during spinal anaesthesia for Caesarean section

et al. 2005

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SummaryWe studied the hypothermic effect of adding 150 lg morphine during spinal anaesthesia in 60 parturients scheduled for elective caesarean section. All the parturients received intrathecal injection of a solution containing 150 lg morphine or normal saline in addition to 10-12 mg hyperbaric bupivacaine 0.5%. In both groups, a significant decrease in body temperature was noted. There was no difference in the area under the curve for temperature against time for the two groups; however, the maximum decrease in temperature from baseline was significantly larger after morphine than after saline injection (mean (SD) 1.11 (0.61)°C vs 0.76 (0.39)°C, respectively; p = 0.01) and the time to nadir temperature was significantly longer (59.5 (17.6) min vs 50.4 (15.9) min, respectively; p = 0.047). The lowest temperature observed in the morphine group was 34.3°C. We conclude that intrathecal injection of 150 lg morphine intensified the intra-operative hypothermic effect of bupivacaine spinal anaesthesia for caesarean section. Intra-operative hypothermia has been reported in parturients receiving spinal anaesthesia [1]. For parturients undergoing caesarean section, bupivacaine is a commonly used agent for providing spinal anaesthesia. When morphine is used in addition to local anaesthetics, it prolongs the duration of analgesia and provides postoperative pain relief [2]. Severe hypothermia has been reported when a large dose of morphine was used in spinal anaesthesia [3]. Although hypothermia associated with smaller doses of morphine has been reported sporadically [4,5], it is not known whether a very small dose of morphine (150 lg) would also intensify spinal anaesthesia-induced hypothermia. This randomised double-blind controlled study was performed to evaluate the effect of adding 150 lg of morphine to bupivacaine on body temperature in parturients during elective caesarean section under spinal anaesthesia. MethodsWe included 60 term pregnant women (ASA physical status 1-2) scheduled for elective caesarean section after informed consent. This study was approved by the institutional reviewing board. The individuals were assigned to receive either morphine or saline by a computer-generated randomisation table. The assignments were blinded to both the parturients and the anaesthetists who performed the spinal injection and measured the body temperature. After the parturients were transferred to the operating room, regular noninvasive blood pressure was recorded every 3 min. Lead-II configuration of the ECG and pulse oximetry were continuously displayed. Body temperatures were recorded from the same ear with an infrared tympanic thermometer (Welch Allyn 9000, accuracy ± 0.2°F). The room temperature was kept constant at 24°C. The parturients were prehydrated with 1000 ml Hartmann's solution, which was prewarmed to 37°C. After hydration, the baseline body temperature was obtained. A 27-G Quincke spinal needle was introduced into the subarachnoid space at the L2-3 or L3-4 interspace in the lateral decubitus position, and 10-...

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“…Although hypothermia is common following cesarean delivery resulting from the sympathectomy of regional anesthesia, the potential contribution of neuraxial morphine to post-cesarean hypothermia has received limited attention. [7][8][9] We report on a series of patients who experienced what we believe to be symptomatic hypothermia due to intrathecal morphine. After collecting this series, we undertook an observational study to identify the nature and incidence of presumed morphine-induced hypothermia in the obstetric population.…”

Section: Introductionmentioning

confidence: 99%

Hypothermia after cesarean delivery and its reversal with lorazepam

Hess

Snowman

Wang

2005

International Journal of Obstetric Anesthesia

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Hypothermia and excessive sweating following intrathecal morphine in a parturient undergoing cesarean delivery

Abstract: Intrathecal morphine may cause disruption of thermoregulation resulting in hypothermia associated with excessive sweating.

Cited by 18 publications

References 17 publications

Persistent hypothermia after intrathecal morphine: case report and literature review

Persistent hypothermia after intrathecal morphine: case report and literature review

A randomised double‐blind controlled study evaluating the hypothermic effect of 150 μg morphine during spinal anaesthesia for Caesarean section

Hypothermia after cesarean delivery and its reversal with lorazepam

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