Intrathecal morphine for postoperative analgesia in an infant with bronchopulmonary dysplasia following upper abdominal surgery.

We present a case of severe bronchopulmonary dysplasia in which intrathecal morphine was successfully used for analgesia after a Nissen fundoplication and gastrostomy. Various options for anaesthesia are discussed with the knowledge that two previous procedures had been complicated by congestive cardiac failure and increased respiratory failure.

Intrathecal morphine (ITM) for postoperative pain control in children: a comparison with nalbuphine patient controlled analgesia (PCA).

This is a retrospective study covering the ten-year period 1984-1993. Single shot spinal morphine (ITM) is compared with PCA nalbuphine for postoperative pain relief in children having abdominal or thoracic procedures. The records of 52 patients meeting selection criteria were examined. Nursing and physician notations were reviewed for hourly pain assessments, evidence of associated complications, respiratory depression, nausea and or vomiting, pruritus, and urinary retention. ITM provided significantly better pain relief (2.2 h in pain) during the first 24 h postoperatively than PCA nalbuphine (9.2 h in pain). With the exception of urinary retention which was significantly more frequent following ITM (58.6%) compared to PCA nalbuphine (8.7%), narcotic related complications were not different between the two groups. No difference in duration of hospital stay or ICU stay could be demonstrated. We conclude that ITM provides better pain relief, without more serious complications, than PCA nalbuphine. We recommend it as a safe, effective technique to treat postoperative pain in children following thoracic or upper abdominal procedures.

The effects of propofol anesthesia on transcortical electric evoked potentials in the rat.

The effects of halogenated anesthetic agents on somatosensory and motor evoked potentials (MEP) have been documented previously. Intravenous anesthetic propofol has not yet been used during MEP monitoring. This study investigates the effects of propofol on transcortical MEP in rats during bolus, infusion, and recovery conditions. After baseline MEP recordings, animals received a hetastarch bolus, followed by a propofol (10 mg/kg) bolus dose. A propofol infusion (10 mg/kg/h) and a hetastarch infusion were then begun. MEP recordings were obtained after the propofol bolus, during the infusion, and after a 30-minute recovery phase. Blood pressure readings remained stable. MEP onset latency increased, and amplitude decreased. Response duration diminished. All values returned towards the baseline during recovery. Our results show that the effects of propofol on MEPs are similar to its effects on somatosensory evoked potentials. Propofol seems to be a reasonable agent for use during intraoperative MEP monitoring and should be further investigated for use during spinal cord monitoring in humans.

Anesthesia in 'stone man': myositis ossificans progressiva.

Myositis ossificans progressiva is a rare disease leading to complete ossification of the muscular system. Very little information about this rare disease and its anesthetic implications has appeared in anesthetic literature. This disease is felt to have an autosomal dominant pattern of inheritance and is usually associated with anomalies of the hands and feet. Afflicted patients are frequently misdiagnosed in childhood as having a rheumatologic disorder. Later in life (as true bone is formed in striated muscle, ligaments, and fascia), the correct diagnosis becomes obvious. Although muscles of the heart, diaphragm, larynx, and sphincters are spared, those of the chest wall are not, and pulmonary function progressively deteriorates. Death frequently occurs as a result of a pulmonary infection. Specific anesthetic considerations include positioning to avoid injury, potential need for fiberoptic intubation or tracheostomy, decreased thoracic compliance with the need for increased ventilating pressures, and the ultimate in disuse atrophy contraindicating the use of succinylcholine. Myositis ossificans progressiva can present the anesthesiologist with interesting challenges. Anesthetic management will need to be individualized according to the severity of the disease.

Naloxone: report of a beneficial side effect.

We report two cases. The first was an unexpected, complete resolution of an acute unilateral neurologic deficit associated with anesthesia when naloxone was administered to reverse residual narcotic effect. The second was a complete resolution of postoperative unilateral electroencephalographic evidence of ischemia after naloxone administration in a patient following a carotid endarterectomy. A literature search suggests that naloxone may be useful in the treatment of acute and hyperacute stroke due to ischemia.