buprenorphine and Leiomyoma

We report an anesthetic management of a 45 year-old female patient with dystrophia myotonica who was scheduled for abdominal total hysterectomy. The patient was diagnosed as dystrophia myotonica 8 years ago. Epidural catheterization was performed through Th12-L1 interspace and spinal anesthesia was performed through L2-3 interspace using 3.3 ml of 0.5% bupivacaine. Adequate block below Th5 level was obtained. The intraoperative course of anesthesia was uneventful. Moreover, the continuous epidural administration of buprenorphine gave a satisfactory postoperative pain relief and no respiratory depression was observed. Spinal or epidural anesthesia seems to be effective and safe for the patient with dystrophia myotonica.

Topics: Anesthesia, Epidural; Anesthesia, Spinal; Buprenorphine; Female; Humans; Hysterectomy; Leiomyoma; Middle Aged; Muscular Dystrophies; Pain, Postoperative; Uterine Neoplasms

In this randomized, double-blind, placebo study, the respiratory effects of a single dose of sublingual buprenorphine (0.4 mg) were examined and compared with those induced by one dose of intramuscular morphine (10 mg) in a population of women, aged 25-65 years, admitted at the Hospital for Elective Surgery because of uterine fibromyomatosis. Some indices of control of breathing (P0.1, VT/TI, VE, VA, TI, TE, TI/TTot, RR), gas exchange parameters (D[A-a]O2, VD/VT, PAO2) and blood gases (PaO2, PaCO2) were measured in basal condition and at 30, 60, 90, 180 and 360 min after the administration of the drugs. No significant changes of the respiratory function were observed in patients who have received sublingual buprenorphine. In the morphine-group, however, mild PaO2 decrease and PaCO2 increase were found at 60 and 90 min (p less than 0.05), without any reduction of the respiratory drive activity, as shown by P0.1, VT/TI and VE. The significant FRC reduction, observed in the morphine-group (p less than 0.05), could have induced both TE shortening and RR increase with larger dead space ventilation and consequent fall of VA (p less than 0.05). These results suggest that the administration of one dose of sublingual buprenorphine (0.4 mg) does not cause any detrimental respiratory effect; on the other hand, an appreciable, although clinically trivial, worsening of the respiratory function results from intramuscular morphine (10 mg), in the absence of any obvious respiratory depression.

Topics: Administration, Sublingual; Adult; Aged; Airway Resistance; Buprenorphine; Double-Blind Method; Female; Functional Residual Capacity; Humans; Injections, Intramuscular; Leiomyoma; Middle Aged; Morphine; Pulmonary Gas Exchange; Respiration; Tidal Volume; Time Factors; Uterine Neoplasms