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Canadian Journal of Anaesthesia

, Volume 45, Issue 1, pp 60–62 | Cite as

Acute respiratory depression as a complication of nebulised morphine

  • Eric LangEmail author
  • Robert Jedeikin
Clinical Reports

Abstract

Purpose

To present a case of respiratory depression following the administration of nebulised morphine.

Clinical features

A 74-yr-old, 51-kg woman with a history of hypertension controlled with 5 mg·day−1enalapril and 50 mg·day−1 atenolol was admitted for evaluation of low back pain, loss of appetite, and weight loss. Investigation revealed advanced metastatic disease with a probable primary in the right lung. The patient’s pain was well controlled with 10 mg continuous release morphinepo three times daily, and 10 mg immediate release morphine po for breakthrough pain as required. During the two weeks following the commencement of this treatment she occasionally complained of shortness of breath. Examination revealed a fully conscious patient with slight dyspnoea and mild wheezing which responded to oxygen 30% and nebulised bronchodilators.

An oncological consultation recommended 4 mg nebulised morphine and 4 mg dexamethasone in saline as treatment for the bouts of breathlessness. Approximately 15 min after the first administration of nebulised morphine the patient became markedly bradypneic (respiratory rate: 4–5 bpm), hypotensive (BP 70/40 mmHg), and responded only partially to command. The pupils were pinpoint. The trachea was immediately intubated and the lungs ventilated with oxygen 40% for four hours. Following this occurrence of respiratory depression nebulised morphine was discontinued and no further events occurred.

Conclusion

Patients receiving inhaled morphine should be closely monitored and resuscitation equipment should be readily available.

Keywords

Chronic Obstructive Pulmonary Disease Morphine Interstitial Lung Disease Respiratory Depression Breakthrough Pain 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif

Présenter un cas de dépression respiratoire consécutive à l’administration de morphine par nébulisation.

Éléments cliniques

Une patiente de 74 ans pesant 51 kg, hypertendue contrôlée sous enalapril 5 mg·j−1 et aténolol 50 mg·j−1 était admise pour l’évaluation d’une lombalgie, d’une perte d’appétit et de poids. L’investigation révélait la présence d’un cancer métastastique avancé originaire du poumon droit. La douleur était bien contrôlée avec de la morphine 10 mg à libération continuellepo trois fois par jour et 10 mg de morphine à libération immédiatepo pour les douleurs rebelles au besoin. Pendant les deux semaines qui ont suivi le début du traitement, la patiente s’est plainte de dyspnée occasionnelle. L’examen a révélé une patiente complètement consciente avec de la dyspnée et du wheezing léger répondant favorablement à l’oxygène 30% et aux bronchodilatateurs en nébulisation. Pour traiter les attaques de dyspnée, une consultation en oncologie recommandait 4 mg de morphine en nébulisation et 4 mg de dexaméthazone dans du sol. phys. Quinze minutes après la première nébulisation de morphine, la patiente est devenue considérablement bradypnéique (fréquence respiratoire : 4–5 r·min−1), hypotendue (TA 70/40 mmHg) et ne répondait que partiellement aux ordres. Les pupilles étaient en myosis très serré. La trachée a été intubée immédiatement et les poumons ventilés avec de l’oxygène 40% pendant quatre heures, Après cet incident, la nébulisation de morphine a été cessée et on n’a pas observé de récidive du même type.

Conclusion

Les patients recevant de la morphine en inhalation doivent être surveillés de près et le matériel de réanimation doit être gardé à portée de main.

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Copyright information

© Canadian Anesthesiologists 1998

Authors and Affiliations

  1. 1.Department of Anesthesiology and Critical Care Medicine Meir HospitalKfar SabaIsrael
  2. 2.Sackler School of MedicineTel-Aviv UniversityTel-AvivIsrael

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