Incidence Of Respiratory Depression Research Articles

Intrathecal narcotics for obstetric analgesia in a community hospital

Our objective was to establish whether intrathecal narcotics for obstetric analgesia offer an adequate and cost-effective alternative to epidural analgesia with minimal side effects in our small, semirural community hospital with limited anesthesia coverage. Low-risk patients at > or = 35 gestational weeks in active labor were offered intrathecal narcotics. A retroactive chart review of every patient receiving an intrathecal injection was compared with a chart review of the next consecutive low-risk patient who did not receive an intrathecal narcotic. Age, parity, and status of labor at the time of application were noted, as was the subsequent rate of labor and the type of delivery. Side effects such as changes in vital signs, headache, vomiting, pruritus, urinary retention, and/or respiratory depression were noted. All study patients received fentanyl, 25 to 35 micrograms, plus 0.25 to 0.3 mg of preservative-free morphine combined with 6 to 8 mg of lidocaine. Within 15 minutes of delivery intravenous nalbuphine (Nubain), 5 mg, and oral naltrexone, 12.5 mg, were administered. Pain relief was recorded as excellent, satisfactory, or unsatisfactory (requiring additional medication). During the 30-month review period, 90 patients (3% of total deliveries) received intrathecal narcotics. There were three sets of twins, for a total of 93 live births. Ten patients (11%) required primary cesarean section, and of the 83 vaginal births 35 (38%) were spontaneous, two (2%) required forceps deliveries, and 46 (49%) were delivered by vacuum extraction, which was significantly higher than the 28 (31%) for controls. The rate of labor was not affected, with both groups requiring a similar rate of oxytocin (Pitocin) augmentation. Significantly more patients receiving intrathecal narcotics experienced pruritus and urinary retention compared with controls. There was no incidence of respiratory depression. Eighty-four (93%) of the 90 patients reported excellent pain relief, five patients had satisfactory relief lasting 2.5 to 6 hours, and one was unsatisfactory. In our hospital with limited anesthesia services intrathecal narcotics offer excellent labor pain relief with manageable side effects and without adverse obstetric outcome.

Continuous Epidural Analgesia Using Fentanyl and Bupivacaine After Total Knee Arthroplasty

Eighty consecutive patients undergoing unilateral total knee arthroplasty received postoperative analgesia consisting of a continuous epidural infusion of fentanyl and bupivacaine. Nineteen patients (24%) were unable to complete the three-day course of epidural infusion: two thirds for technical reasons and one third because of adverse effects. The remaining 61 patients (76%) successfully completed the 72-hour protocol. The benefits in this group included a shorter hospital stay (8.3 versus 9.5 days, p < 0.01) and earlier return of flexion (p < 0.05) as compared with the group that had the epidural catheter removed prematurely. When compared with previous experiences with continuous epidural analgesia using Duramorph and bupivacaine for the first three days after TKA in 56 patients, the current group of 80 patients had shorter average hospitalization (8.6 versus 9.7 days, p < 0.01) and earlier return of flexion (p < 0.001). Patient acceptance was excellent with either agent. Confusion and pruritus were significantly less common with fentanyl, but the incidence of hypotension was increased. Nausea was problematic in both groups. The incidence of respiratory depression was 5% for either opiate. The degree of hypoventilation and treatment required for it were less severe with fentanyl, however.

The technique and efficacy of axillary catheter analgesia as an adjunct to distraction elbow arthroplasty: A prospective study

A prospective study was done on 99 consecutive patients who underwent distraction elbow arthroplasty and postoperative continuous passive motion from 1986 to 1992. Postoperative axillary catheter infusion in 73 patients was compared with patient-controlled analgesia-opioid treatment in 26 patients. Group comparisons for analgesia, complications, time to initiation, and tolerance of postoperative continuous passive motion were made. The postoperative axillary catheter infusion group was more comfortable and had better postoperative continuous passive motion compliance than did the patient-controlled analgesia-opioid group. The postoperative axillary catheter infusion group had a 2.7% (2 of 73) incidence of respiratory toxicity. There was an 11.5% (3 of 26) incidence of respiratory depression in the patient-controlled analgesia-opioid group. Final arc range of motion was similar between postoperative axillary catheter infusion and patient-controlled analgesia-opioid groups. The data support the hypothesis that postoperative axillary catheter infusion provides better patient comfort and earlier postoperative continuous passive motion initiation, but they do not show additional improvement in the final arc of motion after distraction elbow arthroplasty as compared with a patient-controlled analgesia-opioid treatment group.

Intrathecal morphine for the relief of post‐hysterectomy pain ‐ a double‐blind, dose‐response study

Eighty patients undergoing total abdominal hysterectomy under general anaesthesia were randomly divided into four groups to study the dose-response relationship of intrathecal morphine (0, 0.1, 0.3 and 0.5 mg) for postoperative pain relief. Pain scores, as assessed by using the visual analogue scale, revealed that intrathecal morphine provided long-lasting pain relief, was most effective after 0.3 mg and significantly reduced the need for supplementary analgesics (P < 0.05). There was no difference as regards the quality of analgesia or the use of supplementary analgesics between the 0.3 and 0.5 mg groups. Adequate pain relief was not evident after a 0.1 mg dose. There was no incidence of respiratory depression in any of the patients in this study. The incidence of side effects was least following 0.3 mg intrathecal morphine, which we consider to be the optimum dose.

Intrathecal Morphine Dose-Response Data for Pain Relief After Cholecystectomy

We studied the effect of low-dose intrathecal morphine (0.00-0.20 mg) on pain relief and the incidence of side effects after cholecystectomy in 139 patients divided into eight groups according to intrathecal morphine dose: groups 1 (0.00 mg), 2 (0.04 mg), 3 (0.06 mg), 4 (0.08 mg), 5 (0.10 mg), 6 (0.12 mg), 7 (0.15 mg), and 8 (0.20 mg). Preservative-free morphine hydrochloride mixed in hyperbaric tetracaine solution was administered at the time of induction of spinal anesthesia just before surgery. Pain relief was significantly greater for the first 24 h in groups 3, 4, 5, 6, 7, and 8 than in group 1. The incidence of respiratory depression was significantly greater in groups 7 and 8 than in the other groups in the first 48 h. Vomiting occurred significantly more often in group 1 than in groups 2, 3, 4, and 5. Intraoperative cholangiography and the postoperative clinical course indicated no increase in tone of the sphincter of Oddi in any patient. We conclude that 0.06-0.12-mg intrathecal morphine is the best dose range for pain relief after cholecystectomy without respiratory depression and with the lowest incidence of vomiting or pruritus, or both.

Intrathecal Morphine for Post-Thoracotomy Pain

We wished to investigate possible differences in the duration of postoperative analgesia and the incidence of respiratory depression after the intrathecal injection in the lumbar area of 10 micrograms/kg morphine in hypobaric and hyperbaric solution for relief of post-thoracotomy pain. Twenty-nine patients received morphine plus dextrose (hyperbaric) and 21 received morphine in preservative-free normal saline. The duration of analgesia was longer with the morphine in the normal saline group than in the hyperbaric group (P less than 0.04). One patient developed delayed respiratory depression. Our data support the use of morphine in normal saline mixtures for greater duration of analgesia after thoracic operations.

Evaluation of an alphaprodine-hydroxyzine combination as a sedative agent in the treatment of the pediatric dental patient

This investigation proposed and evaluated a submucosally administered standard dose drug combination containing .6 mgm/kgm alphaprodine hydrochloride and .3 mgm/kgm hydroxyzine hydrochloride, in conjunction with nitrous oxide, oxygen, and lidocaine with epinephrine, in the sedation and treatment of uncooperative pediatric dental patients. Observations from this study include: The technique was successful in attaining a desirable, conscious sedation level that was characterized by rapid onset, maintenance throughout treatment, and rapid reversibility with naloxone and 100% oxygen. The protective airway reflexes remained intact during the procedures. Vital signs remained fairly constant throughout the treatment. Respiratory rate was slightly depressed during the sedation, but hemoglobin oxygen saturation levels remained constant. There were no incidences of respiratory depression, hypoxia, or apnea either during or after treatment, and no emergency medical or resuscitative efforts were necessary. Twenty-four hours after the appointment, few patients complained of the experience and more than half stated that they looked forward to returning. In view of these findings, the techniques and drug combination described in this investigation appear to provide a safe and effective means for the sedation and treatment of uncooperative pediatric dental patients. It should be emphasized, however, that the dentist using these methods should have a thorough knowledge of the agents involved, the ability to monitor patients and recognize possible adverse reactions, and the capacity to respond to any emergency situations should they arise. Consequently, only practitioners who have had extensive training and experience in all forms of anesthesia, especially pediatric anesthesia, should consider the use of these agents in their practices. It should be emphasized further that the agents and techniques should be used only for conscious sedation, the light level of sedation during which the patient retains the ability present before sedation to independently maintain an airway and respond appropriately to verbal command, and not for any deeper forms of anesthesia.

Interactions of CNS Drugs Psychotherapeutic Agents — The Antianxiety Drugs

A review of the literature of drug interactions of the antianxiety agents yields little of clinical significance. Recorded drug interactions of this group involve primarily meprobamate, chlordiazepoxide, and diazepam. The only interaction of note with meprobamate is the development of tolerance partially as a result of microsomal enzyme induction by meprobamate, chronic alcohol ingestion, and possibly some other agents. Of the benzodiazepine interactions, the one of most serious note is the incidence of respiratory depression and/or hypotension which occurs when diazepam is given intravenously for convulsions after prior parenteral administration of a barbiturate. The benzodiazepine derivatives may inhibit diphenylhydantoin metabolism. Hence, patients on diphenylhydantoin therapy should be closely monitored when the benzodiazepine anti-anxiety agents are introduced to or deleted from the therapeutic regimen.

METHOHEXITONE AND THIOPENTONE: Response to stimuli and incidence of some side effects

SUMMARY Over 600 patients were anaesthetized for minor urological procedures with either methohexitone or thiopentone, to compare the analgesic or antanalgesic effects of these drugs. Movement in response to preparation with a cold solution was more frequent after methohexitone. After 200 cases the dosage was increased by 20 per cent so as to reduce the incidence of this response, and this increased dose was given to the next 400 patients. This caused an increase in the proportion of patients responding to cold; there was also a marked increase in the incidence of respiratory depression and of hiccup; hiccup was linked with passive ventilation of the lungs. The incidence of arterial hypotension and respiratory depression was the same with both drugs. There was no significant difference in the incidence of movement during the passage of a cystoscope or bouginage, perhaps because by then the patient had received some inhalation anaesthesia.

The use of chlorpromazine in obstetrical analgesia

1.1. We have studied 628 obstetrical deliveries in which chlorpromazine was used as part of the medication to produce analgesia and amnesia. The dose varied from 25 to 150 mg. The average patient received, in all, chlorpromazine, 50 mg., meperidine, 100 mg., and scopolamine, 1.2 mg.2.2. Chlorpromazine had no effect on the duration of labor.3.3. It did not increase the total number of operative deliveries but may have increased the incidence of midforceps.4.4. The incidence of respiratory depression in the infants of the chlorpromazine patients was less than one half that found among the babies delivered in the year prior to the use of this drug.5.5. There was only one episode of hypotension in the whole series. There was no incidence of jaundice. Also, there were no significant hypotension and no jaundice in approximately 1,800 other women, patients of other doctors, who were delivered in the same hospital during the course of this study.6.6. The patients were quiet and cooperative, and the incidence of amnesia was nearly 100 per cent.