The effect of baricity of intrathecal morphine in children receiving tetracaine spinal anaesthesia for cardiac surgery: a preliminary report

Finkel, Julia C.; Boltz, M. Gail; Conran, Aisling

doi:10.1046/j.1460-9592.2002.00869.x

Cited by 2 publications

(2 citation statements)

References 18 publications

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“…While it may be argued that administration via the more commonly used epidural/caudal route would diminish the exposure of the cord to high concentrations, we would note the following points. 1) Intrathecal morphine has been used in children following major surgery for many years, administered either as a single bolus55,93,94 or via continuous infusion;95,96 and intrathecal morphine has also been administered to neonates and infants following cardiac surgery17,18,97,98 and major craniofacial surgery99. 2) The use of spinal anesthesia in neonates and infants is increasing14 and the limited duration of action of local anesthesia may be improved by co-administration with spinal opioid19.…”

Section: Discussionmentioning

confidence: 99%

Validation of a Preclinical Spinal Safety Model

et al. 2010

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Background Preclinical studies demonstrate increased neuroapoptosis after general anesthesia in early life. Neuraxial techniques may minimize potential risks, but there has been no systematic evaluation of spinal analgesic safety in developmental models. We aimed to validate a preclinical model for evaluating dose-dependent efficacy, spinal cord toxicity, and long term function following intrathecal morphine in the neonatal rat. Methods Lumbar intrathecal injections were performed in anesthetized rats aged postnatal day (P)3, 10 and 21. The relationship between injectate volume and segmental spread was assessed post mortem and by in-vivo imaging. To determine the antinociceptive dose, mechanical withdrawal thresholds were measured at baseline and 30 minutes following intrathecal morphine. To evaluate toxicity, doses up to the maximum tolerated were administered, and spinal cord histopathology, apoptosis and glial response were evaluated 1 and 7 days following P3 or P21 injection. Sensory thresholds and gait analysis were evaluated at P35. Results Intrathecal injection can be reliably performed at all postnatal ages and injectate volume influences segmental spread. Intrathecal morphine produced spinally-mediated analgesia at all ages with lower dose requirements in younger pups. High dose intrathecal morphine did not produce signs of spinal cord toxicity or alter long-term function. Conclusions The therapeutic ratio for intrathecal morphine (toxic dose / antinociceptive dose) was at least 300 at P3, and at least 20 at P21 (latter doses limited by side effects). This data provides relative efficacy and safety data for comparison with other analgesic preparations and contributes supporting evidence for the validity of this preclinical neonatal safety model.

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Section: Discussionmentioning

confidence: 99%

Validation of a Preclinical Spinal Safety Model

et al. 2010

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“…Epidural and IT techniques with opioid and ⁄ or LA are effective for sternotomy pain but only marginal benefits have been demonstrated and there is insufficient data concerning the incidence of serious complications: Grade B (229)(230)(231)(232)(233)(234)(235)(236).…”

Section: Recommendationmentioning

confidence: 99%

Postoperative pain

Howard¹,

Carter²,

Curry³

et al. 2008

Pediatric Anesthesia

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Concentrations associated with arousal in children are analogous to adults. The ability to recall and remember occurs at similar concentrations to those associated with arousal. A concentration of 1 mg.l(-1) was associated with a sedation level of three or less (arouses to consciousness with moderate tactile or loud verbal stimulus) in 95% of children while 1.5 mg.l(-1) was associated with a sedation level of two or less (rouses slowly to consciousness with sustained painful stimulus) in 95% of children. These concentrations can be attained for 3-4 min after 1 mg.kg(-1) and 1.5 mg.kg(-1) ketamine IV bolus, respectively. The mean arousal time can be anticipated at approximately 10 min (1 mg.kg(-1)) and 15 min (1.5 mg.kg(-1)).

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The effect of baricity of intrathecal morphine in children receiving tetracaine spinal anaesthesia for cardiac surgery: a preliminary report

Abstract: When intrathecal morphine is administered in conjunction with a hyperbaric tetracaine spinal to paediatric cardiac patients in the head down position, sequential administration of the hypobaric solution may mitigate side-effects.

Cited by 2 publications

References 18 publications

Validation of a Preclinical Spinal Safety Model

Validation of a Preclinical Spinal Safety Model

Postoperative pain

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