scholarly journals Acute respiratory depression resulting from ten milligram of oral morphine: an unusual case

TMR Cancer ◽  
2021 ◽  
Vol 4 (3) ◽  
pp. 14
Author(s):  
Jie Bai ◽  
Qi Zheng
Keyword(s):  
Respiratory Depression ◽  
Unusual Case ◽  
Oral Morphine

Hair testing in postmortem diagnosis of substance abuse: An unusual case of slow-release oral morphine abuse in an adolescent

2015 ◽  
Vol 36 ◽  
pp. 172-176 ◽  
Author(s):  
Valérie Baillif-Couniou ◽  
Pascal Kintz ◽  
Caroline Sastre ◽  
Phak-Rop Pos Pok ◽  
Marjorie Chèze ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Unusual Case ◽  
Slow Release ◽  
Oral Morphine ◽  
Postmortem Diagnosis ◽  
Hair Testing

scholarly journals Characterization of hospitalized patients who received naloxone while receiving opioids with or without gabapentinoids

2021 ◽  
Vol 11 (4) ◽  
pp. 225-230
Author(s):  
Payal H. Desai ◽  
Olesya Taylor ◽  
Kunal J. Shah ◽  
Kirk E. Evoy ◽  
Alyssa M. Peckham
Keyword(s):  
Respiratory Depression ◽  
Oral Morphine ◽  
Dose Intensity ◽  
Retrospective Chart Review ◽  
Medication Administration ◽  
Patient Specific ◽  
Analgesic Effects ◽  
Cns Depressant ◽  
History Of ◽  
Specific Factors

Abstract Introduction Gabapentin and pregabalin (gabapentinoids) can be given with opioids for opioid-sparing and adjuvant analgesic effects. In the context of certain comorbidities and high dosages, coadministration of these agents can lead to respiratory depression or oversedation, necessitating naloxone administration. Methods A retrospective chart review from January 2015 to December 2017 was conducted to include patients who received naloxone and opioids with or without gabapentinoids. Exclusion criteria included pregnancy or having received naloxone in the emergency department, intensive care, or pediatrics units. The primary outcome was to characterize differences between groups regarding comorbidities, history of renal or hepatic dysfunction, history of SUD, opioid tolerance, initiation and dose appropriateness of gabapentinoids, and dose intensity of gabapentinoids and opioids. Secondary outcomes were concomitant CNS depressant use and naloxone episodes for documented respiratory depression. Results Of 126 patients who met inclusion criteria, 36 received opioids and gabapentinoids (gabapentinoid group) and 90 received opioids alone (nongabapentinoid group). There were 136 naloxone episodes between the 2 groups. More than 50% of the naloxone episodes in the gabapentinoid group involved opioids of at least 90 oral morphine mg equivalents. Respiratory depression accounted for 39% and 15.8% of the naloxone episodes in the gabapentinoid and nongabapentinoid groups, respectively. Discussion There may be increased naloxone episodes among patients receiving opioids and gabapentinoids. Future studies are needed to evaluate the incremental risk of respiratory depression and oversedation as it pertains to concomitant medication administration and patient-specific factors.

scholarly journals Postoperative respiratory depression after hysterectomy

2020 ◽  
Author(s):  
Mariana L. Laporta ◽  
Michelle O. Kinney ◽  
Darrell R. Schroeder ◽  
Juraj Sprung ◽  
Toby N. Weingarten
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Respiratory Depression ◽  
Oral Morphine ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complications ◽  
Opioid Dose ◽  
Factors Associated ◽  
Depression Risk ◽  
Lower Body Weight

To investigate if sex-specific physiologic characteristics could impact postoperative respiratory depression risks in women, we studied incidence and risk factors associated with postoperative respiratory depression in a gynecologic surgical cohort. Only hysterectomies performed under general anesthesia from 2012 to 2017 were included to minimize interprocedural variability. Respiratory depression was defined as episodes of apnea, hypopnea, hypoxemia, pain-sedation mismatch, unplanned positive airway pressure device application, or naloxone administration in the post-anesthesia care unit. Multivariable logistic regression was used to explore the association with clinical characteristics. From 1,974 hysterectomies, 253 had postoperative respiratory depression, yielding an incidence of 128 (95% confidence interval, 114–144) per 1,000 surgeries. Risk factors associated with respiratory depression were older age (odds ratio 1.22 [95% confidence interval 1.02–1.46] per decade increase, p = 0.03), lower body weight (0.77 [0.62–0.94] per 10 kg/m2, p = 0.01), and higher intraoperative opioid dose (1.05 [1.01–1.09] per 10 mg oral morphine equivalents, p = 0.01); while sugammadex use was associated with a reduced risk (0.48 [0.30–0.75], p = 0.002). Respiratory depression was not associated with increased hospital stay, postoperative complications, or mortality. Postoperative respiratory depression risk in women increased with age, lower weight, and higher intraoperative opioids and decreased with sugammadex use; however, it was not associated with postoperative pulmonary complications.

Fibrotische interstitielle Lungenerkrankungen: Supportive und palliative Konzepte in die Behandlung integrieren

2021 ◽  
pp. 70-72
Author(s):  
Fotios Drakopanagiotakis ◽  
Andreas Günther
Keyword(s):  
Respiratory Depression ◽  
Oral Morphine ◽  
Symptom Burden ◽  
Visual Analogue Score ◽  
Interstitial Lung Diseases ◽  
Controlled Study ◽  
Morphine Group ◽  
Increased Risk ◽  
Safety Parameters

Background: Patients suffering from fibrotic interstitial lung diseases (fILD) have a poor prognosis and a high symptom burden. Palliative treatment includes relief of symptoms such as breathlessness. There is no evidence-based treatment for chronic breathlessness but opioids are often used despite concerns due to the hypothetical risk of respiratory depression. This study investigated the effect of oral morphine drops in patients with fILD on chronic breathlessness and safety. Methods: In a double-blinded placebo-controlled study, 36 patients with fILD were randomised to either four daily doses of 5 mg of oral morphine drops or placebo for 1 week. Endpoints and safety parameters were obtained at baseline, at follow-up after 1 h and 1 week. Results: The primary endpoint, the visual analogue score (VAS) of dyspnea was reduced by 1.1 ± 0.33 cm in the morphine group at follow-up compared to baseline (P < 0.01), whereas the reduction was 0.35 ± 0.47 cm in the placebo group. However, the difference between the two groups was not statistically significant (p = 0.2). Oral morphine drops did not affect respiratory frequency, pulse rate, blood pressure, peripheral saturation or the 6-min walk test. More patients treated with morphine reported constipation, nausea and confusion. Conclusions: Oral administration of morphine drops, 20 mg a day, in patients with fILD did not significantly reduce dyspnea VAS score during 1 week compared to placebo. Oral morphine did not induce respiratory depression, but was related to an increased risk of constipation, nausea and confusion. Trial registration: The trial is registered in clinicaltrials.gov (Identifier: NCT02622022). Registered 4 December 2015.

RESPIRATORY DEPRESSION AFTER PERCUTANEOUS CERVICAL ANTEROLATERAL CORDOTOMY IN PATIENTS ON SLOW-RELEASE ORAL MORPHINE

The Lancet ◽  
1984 ◽  
Vol 323 (8379) ◽  
pp. 739 ◽  
Author(s):  
ChristopherJ. Wells ◽  
Sampson Lipton ◽  
Juan Lahuerta
Keyword(s):  
Respiratory Depression ◽  
Slow Release ◽  
Oral Morphine

scholarly journals Surdity in the OR: An Unusual Case of Brainstem Anesthesia

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Howard D. Palte ◽  
Don P. Hoa ◽  
Aldo Pavon Canseco
Keyword(s):  
Case Report ◽  
Respiratory Depression ◽  
Patient Monitoring ◽  
Unusual Case ◽  
Supportive Therapy ◽  
Loss Of Consciousness ◽  
Presenting Symptoms ◽  
Key Points ◽  
Life Threatening ◽  
Life Threatening Complication

Brainstem anesthesia is a potentially life-threatening complication of regional ophthalmic anesthesia. This case report chronicles an unusual presentation of brainstem anesthesia following an eye block. The unique features of this case were the presenting symptoms of deafness and slurred speech in the absence of loss of consciousness, respiratory depression, or contralateral ophthalmoplegia. This report underscores two key points: first, the importance of ongoing patient monitoring after performance of an eye block; second, the exigency of supportive therapy in suspected cases of brainstem anesthesia.

Respiratory Depression following Administration of Intrathecal Bupivacaine to an Opioid-Dependent Patient

1998 ◽  
Vol 32 (6) ◽  
pp. 653-655 ◽  
Author(s):  
Catherine Y Piquet ◽  
Michel P Mallaret ◽  
Aude H Lemoigne ◽  
Claude E Barjhoux ◽  
Vincent C Danel ◽  
...  
Keyword(s):  
Respiratory Depression ◽  
Extended Release ◽  
Intrathecal Morphine ◽  
Oral Morphine ◽  
Opioid Analgesics ◽  
Leg Pain ◽  
Spontaneous Respiration ◽  
Intrathecal Catheter ◽  
Cancer Of The Bladder ◽  
Dependent Patient

OBJECTIVE: To document two cases of respiratory depression in patients receiving morphine once the stimulating effect of pain on respiration was removed by bupivacaine. CASE SUMMARIES: Case 1: A 72-year-old 84-kg white man with cancer of the bladder and bone metastases had intense back and leg pain that was treated with intrathecal morphine for 6 months at an increasing dosage up to 10 mg twice daily. The intrathecal route was avoided for 4 days because of a suspected local infection at the site of the intrathecal catheter. During this 4-day period the patient received extended-release morphine and subcutaneous morphine daily. When the intrathecal route was used again, he received an identical dose of morphine plus bupivacaine and epinephrine. Ten minutes after the injection, fatal respiratory distress occurred. Case 2: A 92-year-old white woman was admitted for revascularization of arteritis on her left leg. To treat a painful sacrum and heel bedsores, she received extended-release oral morphine for 8 days. Induction of the intrathecal anesthesia was performed with bupivacaine. After 10 minutes, the patient became subcomatose, with miosis and apnea. Intravenous naloxone restored spontaneous respiration and normal consciousness. CONCLUSIONS: Pain is a physiologic antagonist of the respiratory depressant effects of opioid analgesics. By reducing pain stimulation, bupivacaine may make patients more susceptible to opioid respiratory depression. Such situations require titration of bupivacaine and other analgesics as well as increased monitoring of the patient.

Variable erythrokeratoderma. An unusual case

1969 ◽  
Vol 100 (6) ◽  
pp. 744-748 ◽  
Author(s):  
F. G. Schellander
Keyword(s):  
Unusual Case

An unusual case of suntanning

1978 ◽  
Vol 114 (2) ◽  
pp. 287b-287
Author(s):  
G. P. Ream
Keyword(s):  
Unusual Case
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