Intraspinal Demerol Anesthesia / 대한마취과학회지

ABSTRACT

Intraspinal morphine anesthesis for open heart surgery was first publicized by Jeon early in 1986. We came to the conclusion that the anesthesia induced by an intraspinal morphine injection was satisfactory in anesthesia practice for open heart surgery and we have called this procedure, "Intraspinal Morphine Anesthesia". However, respiratory depression seemed to be most serious between 12~16hrs, after an intraspinal injection of morphine so that this technique is recommended only in patients who need controlled respiration for more than 12 hours because respiratory arrest occurs more commonly at that time. In other words intraspinal morphine anesthesia is absolutely not recommended in patients for simple operations. This study was undertaken to evaluate the effects of demerol injected in the subarachnoid space and to compare them with the effects of intraspinal morphine anesthesia. This attempt was made to take advantage of the rapid onset and short duration of demerol action for simple and short procedures. We had 32 cases scheduled for open heart surgery but those were all simple cases such as ASD and VSD in which controlled respiration was not expected to be needed. They were anesthetized mainly by intraspinal demerol and intravenous tranquilizers with 100% oxygen throughout the surgery. 1) The dosage of intraspinal demerol which ranged between 1~2 mg/kg did not seem to be proportional to the duration and potency of the drug. 2) Valium was administered intravenously to eliminate intraoperative awareness. Valium was preferred to Activan for simple cases. 3) The main action of demerol seemed to last 3~4 hours and no respiratory problems were observed 4 hours after the injection of demerol. 4) The onset of an anlgesic effect appeared at 5~7 minutes and the respiratory depression or arrest occuresd around10 minutes after the injection. 5) Cardiovascular dynamics appeared stable throughout the surgery except for transient bradycardia with mild hypotension whcih was seem occasionally. 6) Respiratory depression seemed to be no problem in the recovery room and ICU periods. 7)Somnolence lasts around 2~4 hours with no inadvertent resctions. 8) documented complications such as pruritus and voiding difficulty were not problems with the use of demerol for open heart surgery. 9) The aneshtesia induced by intraspinal demerol injection was satisfactory in anesthesia practice for simple cases. Therefore, we have called this procedure "Intraspinal Demerol Anesthesia". However, this technique sometimes is inconvenient in clinical practice because of its short action.