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Accidental Intrathecal Morphine Overdose During the Surgery: A Case Report and Literature Review
Dafni Andromachi Antonaki1, Emmanouil Stamatakis2, Giolanda Varvarousi2
1Department of Anesthesiology, Laiko General Hospital of Athens, Athens, GRC.
Abstract:
Neuraxial anesthetic techniques have become part of the multimodal analgesia approach for gynecologic surgeries. Specifically, intrathecal morphine is one of the opioids most commonly used for prolonged pain management postoperatively. However, doses above a certain threshold pose a greater risk of adverse effects, especially respiratory complications. This case highlights the challenges faced during the management of an accidental administration of a tenfold dose of morphine in the subarachnoid space for a patient subjected to major gynecologic surgery. Surprisingly, yet to our advantage, the patient exhibited no evidence of the anticipated adverse effects and no further intervention was required. A key indicator that was crucial in identifying the mistake was a diminution in the minimal alveolar concentration (MAC) of the anesthetic agent used.
Insights
A tenfold overdose of intrathecal morphine in gynecologic surgery surprisingly caused no adverse effects. A drop in anesthetic agent concentration (MAC) was key to detecting the accidental overdose.
Area of Science:
- Anesthesiology
- Pharmacology
- Gynecologic Surgery
Background:
- Neuraxial anesthesia is integral to multimodal analgesia for gynecologic procedures.
- Intrathecal morphine is frequently used for extended postoperative pain relief.
- High doses of intrathecal morphine increase risks of adverse events, particularly respiratory depression.
Observation:
- This case details the management of a ten-fold accidental overdose of intrathecal morphine during major gynecologic surgery.
- The patient unexpectedly showed no signs of the expected adverse effects.
- No additional interventions were needed for the patient.
Findings:
- The accidental overdose did not lead to anticipated complications such as respiratory depression.
- A significant decrease in the minimal alveolar concentration (MAC) of the anesthetic agent was observed.
- This change in MAC served as a critical indicator of the morphine overdose.
Implications:
- This case suggests a potential for higher tolerance to intrathecal morphine in certain clinical scenarios.
- Monitoring MAC may be a valuable tool for detecting inadvertent neuraxial opioid overdoses.
- Further research is warranted to understand the mechanisms behind this unexpected tolerance and the utility of MAC monitoring.
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