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Pethidine reverses morphine-induced delirium
1Department of Anaesthesia, Royal Perth Hospital, Western Australia.
Anaesthesia and Intensive Care
|June 15, 2000
Abstract:
A young patient had unexpected and prolonged postoperative delirium apparently associated with morphine-induced biliary colic. Naloxone had no therapeutic effect, but a small dose of pethidine produced a dramatic return to lucidity. Unrecognized biliary spasm should be considered as a cause of agitation in the recovery room in postoperative patients who have received morphine.
Insights
Postoperative delirium in a young patient was linked to morphine-induced biliary colic. A small dose of pethidine rapidly resolved the delirium, suggesting biliary spasm as a potential cause.
Area of Science:
- Anesthesiology
- Pharmacology
- Gastroenterology
Background:
- Postoperative delirium is a common complication.
- Morphine is frequently used for pain management post-surgery.
- Biliary colic can cause significant abdominal pain and distress.
Observation:
- A young patient experienced prolonged postoperative delirium.
- The delirium was suspected to be associated with morphine-induced biliary colic.
- Naloxone administration did not alleviate the symptoms.
Findings:
- A small dose of pethidine resulted in a rapid and complete return to lucidity.
- This suggests that the delirium was primarily caused by biliary spasm rather than opioid-induced central nervous system depression.
- Morphine can precipitate or exacerbate biliary spasm.
Implications:
- Unrecognized biliary spasm should be considered in postoperative patients presenting with agitation or delirium after morphine administration.
- This case highlights the importance of considering atypical side effects of common analgesics.
- Further investigation into the mechanism of morphine-induced biliary spasm may be warranted.