title: [Persisting respiratory depression following intrathecal administration of morphine and simultaneous sedation with midazolam].
abstract: A 72-year-old patient received 0.1 mg morphine by the intrathecal route and 2 x 1.5 mg midazolam as adjuvant therapy. Severe respiratory depression and somnolence supervened 3.5 h later, which lasted over the next 24 h and necessitated intubation and mechanical ventilation. Continuous administration of >6 mg naloxone to antagonize the supposed effect of the morphine had no effect. The patient's condition was not normalized until a single dose of 0.3 mg flumazenil was administered. For the time being, especially in the case of elderly patients, we recommend that strict indications are adhered to when intrathecal administration of morphine is considered and that less than 0.1 mg morphine is given. Diazepines should be avoided. Respiration should be monitored for quite some time.
authors.affiliation: Abteilung für Anästhesie und Intensivmedizin, Kreiskrankenhaus Mühldorf am Inn.
authors.forename: H
authors.initials: H
authors.lastname: Dworzak
authors.forename: F
authors.initials: F
authors.lastname: Fuss
authors.forename: T
authors.initials: T
authors.lastname: Büttner
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D005442:Flumazenil / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D007278:Injections, Spinal; D007442:Intubation, Intratracheal; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects*; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects*; D009270:Naloxone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000139:chemically induced* / Q000628:therapy
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009292:Narcotic Antagonists; D009270:Naloxone; D005442:Flumazenil; D009020:Morphine; D008874:Midazolam