Document Detail


Respiratory depression following epidural morphine in an infant of three months of age.
MedLine Citation:
PMID:  9041576     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Epidural administration of combinations of opioids and a local anaesthetic provides prompt and effective analgesia and is increasingly used in paediatric anaesthesia. However, respiratory depression by rostral spread of opioid in the CSF is by far the greatest concern after epidural morphine. An infant of three months of age underwent portoenterostomy (Kasai's operation) for extrahepatic biliary duct atresia. A median approach at the L3-L4 epidural interspace was used and a dose of 1 ml.kg-1 of 0.125% bupivacaine with adrenaline 1:400000 mixed with 50 micrograms.kg-1 morphine was injected using a 19 gauge Tuohy needle. Six h after epidural morphine, the infant developed respiratory depression with an increase in drowsiness, miosis and decreased respiratory rate. Low arterial saturation (SpO2) was detected by pulse oximetry and confirmed by blood gas analysis. An intravenous bolus of 5 micrograms.kg-1 naloxone followed by a 3-h infusion of 2 micrograms.kg-1.h-1 resulted in complete reversal of signs and symptoms of respiratory depression. Epidural opioids should be limited to paediatric patients admitted to specialized recovery units for the first postoperative day.
Authors:
R Vilà; E Miguel; N Montferrer; G Barat; C Fernández; E González; C Hervàs
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Paediatric anaesthesia     Volume:  7     ISSN:  1155-5645     ISO Abbreviation:  Paediatr Anaesth     Publication Date:  1997  
Date Detail:
Created Date:  1997-05-08     Completed Date:  1997-05-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9206575     Medline TA:  Paediatr Anaesth     Country:  FRANCE    
Other Details:
Languages:  eng     Pagination:  61-4     Citation Subset:  IM    
Affiliation:
Department of Anaesthesia, Hospital Infantil Vall d'Hebron, Barcelona, Spain.
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MeSH Terms
Descriptor/Qualifier:
Analgesia, Epidural / adverse effects*
Analgesics, Opioid / adverse effects*
Biliary Atresia / surgery
Depression, Chemical
Humans
Infant
Male
Morphine / administration & dosage,  adverse effects*
Naloxone / therapeutic use
Respiration / drug effects
Respiratory Insufficiency / chemically induced*
Chemical
Reg. No./Substance:
0/Analgesics, Opioid; 465-65-6/Naloxone; 57-27-2/Morphine
Comments/Corrections
Comment In:
Paediatr Anaesth. 1998;8(1):96   [PMID:  9483611 ]

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


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