Document Detail


Intrathecal morphine for coronary artery bypass grafting and early extubation.
MedLine Citation:
PMID:  9024009     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Aggressive control of pain during the immediate postoperative period after cardiac surgery with early tracheal extubation may decrease morbidity and mortality. This prospective, randomized, double-blinded, placebo-controlled clinical study examined the use of intrathecal morphine in patients undergoing cardiac surgery and its influence on early tracheal extubation and postoperative analgesic requirements. Patients were randomized to receive either 10 micrograms/kg of intrathecal morphine (n = 19) or intrathecal placebo (n = 21). Perioperative anesthetic management was standardized (intravenous (IV) fentanyl, 20 micrograms/kg, and IV midazolam, 10 mg) and included postoperative patient-controlled morphine analgesia. Of the patients who were tracheally extubated during the immediate postoperative period, the mean time from intensive care unit arrival to extubation was significantly prolonged in patients who received intrathecal morphine (10.9 h) when compared to patients who received intrathecal placebo (7.6 h). Three patients who received intrathecal morphine had extubation substantially delayed because of prolonged ventilatory depression. Although mean postoperative IV morphine use for 48 h was less in patients who received intrathecal morphine (42.8 mg) when compared to patients who received intrathecal placebo (55.0 mg), the difference between groups was not statistically significant. In conclusion, intrathecal morphine offers promise as a useful adjunct in controlling postoperative pain in patients after cardiac surgery. However, the optimal dose of intrathecal morphine in this setting, along with the optimal intraoperative baseline anesthetic that will provide significant analgesia, yet not delay extubation in the immediate postoperative period, remains to be elucidated.
Authors:
M A Chaney; P A Furry; E M Fluder; S Slogoff
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  84     ISSN:  0003-2999     ISO Abbreviation:  Anesth. Analg.     Publication Date:  1997 Feb 
Date Detail:
Created Date:  1997-03-04     Completed Date:  1997-03-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  241-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Loyola University Medical Center, Maywood, Illinois 60153, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Analgesia, Patient-Controlled
Analgesics, Opioid / administration & dosage*
Anesthesia, General
Coronary Artery Bypass*
Double-Blind Method
Female
Humans
Infusions, Intravenous
Injections, Spinal
Intubation, Intratracheal*
Male
Middle Aged
Morphine / administration & dosage*
Pain, Postoperative / drug therapy,  prevention & control*
Postoperative Care
Postoperative Complications
Prospective Studies
Time Factors
Chemical
Reg. No./Substance:
0/Analgesics, Opioid; 57-27-2/Morphine
Comments/Corrections
Comment In:
Anesth Analg. 1997 Sep;85(3):706-7   [PMID:  9296440 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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