ABSTRACT
Prone maximal restraint position (PMRP, also known as hogtie or hobble) is often used by law enforcement and prehospital personnel on violent combative individuals in the field setting. Weight force is often applied to the restrained individual's back and torso during the restraint process. We sought to determine the effect of 25 and 50 lbs weight force on respiratory function in human subject volunteers placed in the PMRP. We performed a randomized, cross-over, controlled trial on 10 subjects placed in 4 positions for 5 minutes each: sitting, PRMP, PRMP with 25 lbs weight force (PMRP+25), and PRMP with 50 lbs weight force placed on the back (PMRP+50). We measure pulse oximetry, end-tidal CO2 levels, and forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). FVC and FEV1 were significantly lower in all restraint positions compared with sitting but not significantly different between restraint positions with and without weight force. Moreover, mean oxygen saturation levels were above 95% and mean end-tidal CO2 levels were below 45 mm Hg for all positions. We conclude that PMRP with and without 25 and 50 lbs of weight force resulted in a restrictive pulmonary function pattern but no evidence of hypoxia or hypoventilation.
Subject(s)
Prone Position , Restraint, Physical , Weight-Bearing , Adult , Carbon Dioxide/blood , Cross-Over Studies , Forced Expiratory Volume , Forensic Medicine , Humans , Male , Oximetry , Oxygen/blood , Vital CapacityABSTRACT
OBJECTIVE: To quantitate dose- and time-related magnitudes of interactive effects of morphine (MOR) and isoflurane (ISO) in horses and to characterize pharmacokinetics of MOR in plasma and the ventilatory response to MOR during administration of ISO. ANIMALS: 6 adult horses. PROCEDURE: Horses were anesthetized 3 times to determine the minimum alveolar concentration (MAC) of ISO in O2 and then to characterize the change in anesthetic requirement as defined by the alteration in ISO MAC following IV administration of saline (0.9% NaCl) solution and 2 doses of MOR (low dose, 0.25 mg/kg; high dose, 2.0 mg/kg). Arterial blood samples were obtained before and after MOR and analyzed. RESULTS: Mean +/- SD baseline ISO MAC was 1.43 +/- 0.06%. The ISO MAC did not change with time after administration of saline solution. Effects of MOR on ISO MAC varied. Maximal change in MAC ranged from -20.2 to +28.3% and -18.9 to +56.2% after low and high doses of MOR, respectively. Typical half-life of MOR in plasma was 40 to 60 minutes and related to dose. Mean PaCO2 increased from 70 mm Hg before MOR to 88 to 102 mm Hg for 30 to 240 minutes after the high dose of MOR. Recovery from anesthesia after administration of the high dose of MOR was considered undesirable and dangerous. CONCLUSIONS AND CLINICAL RELEVANCE: Our results do not support routine clinical use of MOR administered IV at dosages of 0.25 or 2.0 mg/kg as an adjuvant to anesthesia in horses administered ISO.
Subject(s)
Analgesics, Opioid/pharmacology , Anesthetics, Inhalation/pharmacology , Horses , Isoflurane/pharmacology , Isoflurane/pharmacokinetics , Morphine/pharmacology , Morphine/pharmacokinetics , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Analgesics, Opioid/pharmacokinetics , Anesthesia/veterinary , Anesthetics, Inhalation/administration & dosage , Anesthetics, Inhalation/adverse effects , Anesthetics, Inhalation/pharmacokinetics , Animals , Blood Pressure/drug effects , Cross-Over Studies , Dose-Response Relationship, Drug , Drug Interactions , Female , Half-Life , Heart Rate/drug effects , Isoflurane/administration & dosage , Isoflurane/adverse effects , Male , Morphine/administration & dosage , Morphine/bloodABSTRACT
A 30-year-old man with chronic abdominal pain was treated with high doses of hydromorphone intravenously and developed severe and frequent myoclonic contractions. Several medications including lorazepam failed to control the contractions; however, clonazepam in normal doses reduced the myoclonus dramatically.
