Morphine respiratory compromise

The coroner concluded that the morphine had contributed to respiratory compromise and death. 

Morphine can cause respiratory compromise, especially when given frequently and in large doses. This client is already at risk for respiratory complications from the emphysema. 

Musculoskeletal Muscle rigidity, laryngo-spasm, and respiratory compromise occurred twice in a 2-day-old full-term neonate, first after a bolus dose of morphine 100 micrograms/kg and then after a continuous infusion of 4.4 micrograms/kg/hour [112 ]. 

The respiratory depression induced by morphine can add to that of alcohol, barbiturates, benzodiazepines (such as Valium), and even with antihistamines taken for allergies. Combined effects of these drugs with morphine can dangerously compromise breathing. Tricyclic antidepressants can hamper the metabolism of morphine. 

Relief of pain after surgery can be achieved with a variety of techniques. An epidural infusion of a mixture of local anaesthetic and opioid provides excellent pain relief after major surgery such as laparotomy. Parenteral morphine, given intermittently by a nurse or by a patient-controlled system, will also relieve moderate or severe pain but has the attendant risk of nausea, vomiting, sedation and respiratory depression. The addition of regular paracetamol and a NSAID, given orally or rectally, will provide additional pain relief and reduce the requirement for morphine. NSAIDs are contraindicated if there is a history of gastrointestinal ulceration of if renal blood flow is compromised. 

Contraindications. Contraindications include hypersensitivity to opioids, head trauma or increased intracranial pressure, severe respiratory depression or compromised respiratory function, and potentially, liver or renal insufficiency (46). Whether morphine or other opioids are used depends on the severity of the contraindication, and the potential benefits must be weighed relative to the risk. Anaphylactoid reactions have been reported after morphine or codeine administered i.v., although the reactions are rare (23). Morphine... 

Fentanyl [437-38-7] (Subhmaze, Leptanal), C22H2gN20, (9) has been extensively used since its introduction into clinical practice in the 1960s (119). Because of its potency, which is 50—100 times that of morphine, a rapid onset of action and a short duration, its use as an iv anesthetic is widespread The short duration results from redistribution from the brain to other tissues, rather than elimination. It does, however, have the usual opiate disadvantages respiratory depression, chest wall rigidity, nausea, and bradycardia. Fentanyl has an extremely wide therapeutic ratio. The size of the dose influences its duration of action which, after iv administration, may last from approximately 30 min to 2 to 3 h (120,121). In cardiac surgery fentanji is administered in very laige doses to produce profound analgesia and suppress cardiovascular reflex responses. This technique is particulady useful for patients with compromised circulation where any increase in cardiac demand could precipitate myocardial ischemia (122). 

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