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On-line version ISSN 1806-907X
Rev. Bras. Anestesiol. vol.56 no.4 Campinas Set./Aug. 2006
LETTER TO THE EDITOR
Hypothermia secondary to subarachnoid administration of morphine
In a recent case report1 we described the development of hypothermia following the subarachnoid administration of morphine. In a randomized double-blind prospective study published in the January 2006 issue of Anesthesia2, a team of researchers from Taiwan showed the relationship between the subarachnoid administration of morphine and the reduction in body temperature. In that study, the average temperature reduction after 150 µg of subarachnoid morphine was 1.1° C, but the tympanic temperature was reduced to as low as 34.3° C. We would like to stress the importance of these results since hypothermia is related to several adverse effects such as increased incidence of infections, coagulation disorders, myocardial ischemia, and pharmacokinetic changes3,4. The use of subarachnoid opioids, especially morphine, is an effective and popular strategy in the postoperative analgesia5. Some adverse effects of this technique, such as pruritus, nausea/vomiting, urinary retention, and respiratory depression have been addressed properly5. However, we believe that this side effect, which is as important or even more important than the ones mentioned above, has not received adequate attention and has not been adequately studied. Our knowledge about it can have direct implications in the choice of the postoperative analgesia, anesthetic technique, perioperative monitoring chosen, and the strategy to preserve the body temperature.
Marcos Guilherme Cunha Cruvinel, TSA
Gustavo Prosperi Bicalho, TSA
Carlos Henrique Viana de Castro, TSA
Roberto Cardoso Bessa Júnior, TSA
01. Bicalho GP, Castro CHV, Cruvinel MGC et al Sudorese profusa e hipotermia após administração de morfina por via subaracnóidea. Relato de caso. Rev Bras Anestesiol, 2006;56:52-56.
02. Hui CK, Huang CH, Lin CJ et al A randomised double-blind controlled study evaluating the hypothermic effect of 150 microg morphine during spinal anaesthesia for Caesarean section. Anaesthesia, 2006;61:29-31.
03. Pestel GJ, Kurz A Hypothermia it's more than a toy. Curr Opin Anaesthesiol, 2005;18:151-156.
04. Biazzotto CB, Brudniewski M, Schmidt AP et al Hipotermia no período peri-operatório. Rev Bras Anestesiol, 2006;56:89-106.
05. Rathmell JP, Lair TR, Nauman B The role of intrathecal drugs in the treatment of acute pain. Anesth Analg, 2005;101:(Suppl5): S30-S43.