buprenorphine and Cardiomyopathies

To develop an alternative anaesthetic regimen for cats with cardiomyopathy, the cardiopulmonary effects of three different premedication-induction protocols, followed by one hour maintenance with isoflurane in oxygen: air were evaluated in six cats. Group I: acepromazine (10 microg/kg) + buprenorphine (10 microg/kg) IM, etomidate (1-2 mg/kg) IV induction. Group II: midazolam (1 mg/kg) + ketamine (10 mg/kg) IM induction. Group III: medetomidine (1.5 mg/m2 body surface) IM, propofol (1-2 mg/kg) IV induction. Heart rate, arterial blood pressure, arterial blood gases, respiration rate, and temperature were recorded for the duration of the experiment. In group I the sedative effect after premedication was limited. In the other groups the level of sedation was sufficient. In all groups premedication resulted in a reduced blood pressure which decreased further immediately following induction. The reduction in mean arterial pressure (MAP) reached statistical significance in group I (142+/-22 to 81+/-14 mmHg) and group II (153+/-28 to 98+/-20 mmHg) but not in group III (165+/-24 to 134+/-29 mmHg). Despite the decrease in blood pressure, MAP was judged to have remained within an acceptable range in all groups. During maintenance of anaesthesia, heart rate decreased significantly in group III (from 165+/-24 to 125+/-10 b.p.m. at t=80 min). During anaesthesia the PCO2 and PO2 values increased significantly in all groups. On the basis of the results, the combination acepromazine-buprenorphine is preferred because heart rate, MAP, and respiration are acceptable, it has a limited sedative effect but recovery is smooth.

Topics: Acepromazine; Analgesics; Analgesics, Non-Narcotic; Analgesics, Opioid; Anesthesia, General; Anesthetics, Intravenous; Animals; Body Temperature; Buprenorphine; Cardiomyopathies; Cats; Dopamine Antagonists; Drug Therapy, Combination; Etomidate; Female; Hemodynamics; Infusions, Intravenous; Ketamine; Male; Medetomidine; Midazolam; Propofol

Buprenorphine/naloxone is used for the treatment of opioid dependence. In the following case, a potential use for the medication combination is explored in the arena of transplant surgery. Psychiatry was consulted for a 29-year-old woman with iatrogenic opioid dependence after bilateral ventricular assist device placement for congenital cardiomyopathy. Her ejection fraction was less than 15% and she was considered a poor candidate for transplant due to drug-seeking behaviors. We transitioned her onto buprenorphine/naloxone to prevent abuse and control symptoms, qualifying her for cardiac transplant. After transplant, we coordinated care with cardiothoracic surgeons to restart buprenorphine/naloxone, and the patient has been stable for 8 months.

Topics: Adult; Buprenorphine; Cardiomyopathies; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Heart Transplantation; Heart-Assist Devices; Humans; Iatrogenic Disease; Naloxone; Narcotics; Opiate Substitution Treatment; Opioid-Related Disorders; Pain, Postoperative; Substance Withdrawal Syndrome

A 2-year-old Japanese girl had transient left ventricular apical ballooning on echocardiography and ST-segment elevation and T-wave inversion on electrocardiogram after withdrawal of bupirenorphine and midazolam. The findings improved within 2 weeks. There are many case reports of adults with takotsubo cardiomyopathy but none in children. Takotsubo cardiomyopathy is not well known by pediatric cardiologists, so pediatric cases may have been overlooked. Awareness of a phenomenon similar to takotsubo cardiomyopathy, even in young children, may be important.

Topics: Age Factors; Analgesics, Opioid; Buprenorphine; Cardiomyopathies; Child, Preschool; Echocardiography; Electrocardiography; Female; Humans; Hypertrophy, Left Ventricular; Midazolam; Respiratory Insufficiency; Substance Withdrawal Syndrome; Ventricular Function, Left