heroin and Hypotension

In this prospective, randomised, double-blind study, we compared the effects of two dosage regimens. Pregnant patients at term were randomly assigned to two groups to be given diamorphine 0.4 mg in hyperbaric bupivacaine 0.5% 2.4 ml or diamorphine 0.4 mg in a volume of hyperbaric bupivacaine 0.5% adjusted according to the patient's height and weight. Adequate anaesthesia was provided in all patients in both groups. The onset of the sensory block for cold and pinprick was faster with the fixed dose regimen (p = 0.01). There were more spinal blocks to above the first thoracic dermatome in the fixed dose group (17.1% vs. 2.2%, p = 0.022). Hypotension occurred in 71.7% vs. 50.0% of patients in the fixed dose and adjusted dose groups respectively (p = 0.035). In the fixed dose group, more patients required ephedrine to treat hypotension (79.5% vs. 56.8%, p = 0.022) and a larger median dose was administered (9 mg vs. 6 mg, p = 0.042). The decrease in mean (SD) arterial pressure was less in the adjusted group (35.0 (16.4) mmHg vs. 28.0 (13.5) mmHg, p = 0.036).

Topics: Adult; Anesthesia, Obstetrical; Anesthesia, Spinal; Anesthetics, Local; Body Height; Body Weight; Bupivacaine; Cesarean Section; Double-Blind Method; Drug Administration Schedule; Ephedrine; Female; Heroin; Humans; Hypotension; Pregnancy; Prospective Studies; Vasoconstrictor Agents

Sixty patients took part in a randomised, double-blind study to compare the analgesic and side effects of three opioid-containing solutions for patient-controlled epidural analgesia following abdominal surgery. Patients in group 1 received a solution containing bupivacaine 0.125% with fentanyl 10 micrograms.ml-1, group 2 bupivacaine 0.125% with diamorphine 125 micrograms.ml-1, group 3 pethidine 2.5 mg.ml-1. All groups received 4 ml.h-1 background infusion and 3 ml boluses every 20 min if necessary. There were no significant differences between the groups in visual analogue scale pain scores (p = 0.537) or volumes of solution used at 24 h (p = 0.351) or 48 h (p = 0.105). Motor block was significantly higher in group 2 (p < 0.004) and pruritus occurred significantly less in group 3 (p < 0.05). We conclude that these three solutions produce equivalent analgesia but that pethidine 2.5 mg.ml-1 may be associated with fewer side effects.

Topics: Aged; Analgesia, Epidural; Analgesia, Patient-Controlled; Analgesics, Opioid; Bupivacaine; Double-Blind Method; Female; Fentanyl; Heroin; Humans; Hypotension; Male; Meperidine; Middle Aged; Pain Measurement; Pruritus; Time Factors

An 18-year-old man developed acute pulmonary edema following heroin overdose. Two days after initial improvement, there was recurrence of hypotension and pulmonary edema with severe hypoxemia refractory to mechanical ventilatory support utilizing positive and end-expiratory pressure. Cardiac catheterization revealed elevated pulmonary capillary wedge pressure suggestive of left ventricular failure. The use of digitalis and diuretics resulted in prompt clinical improvement and ultimate recovery. Evidence is presented indicating that this patient represents an uncommon but important syndrome of acute cardiomyopathy with left ventricular failure which complicates the clinical course of certain cases of heroin overdose. Its physiologic diagnosis is of obvious importance in the choice of proper therapy, thereby increasing the patient's chances of recovery.

Topics: Acute Disease; Adolescent; Heart Diseases; Heart Failure; Heroin; Heroin Dependence; Humans; Hypotension; Male; Pulmonary Edema; Recurrence

Three cases of hypoxic-ischemic leukoencephalopathy were studied. In two patients, the neurologic disorder followed drug overdosage; in the third, the apparent precipitating event was a postoperative myocardial infarction complicated by circulatory insufficiency. All patients were deeply unresponsive, with varying reflex patterns. In all three cases, the brain showed extensive symmetrical necrotic lesions of the central white matter, with minimal damage to gray matter structures. The lesions in case 3 showed, in addition, vascular necrosis and ring hemorrhages. Common to all cases was a prolonged period of hypoxemia, hypotension, and elevated venous pressure. Acidosis occurred in two. These observations and analysis of previous reports of similar cases suggest that leukoencephalopathy tends to occur when the hypoxemia is prolonged and is associated with periods of hypotension and metabolic imbalance.

Topics: Adult; Aged; Brain; Brain Damage, Chronic; Female; Glutethimide; Heroin; Humans; Hypotension; Hypoxia, Brain; Ischemia; Male; Myocardial Infarction

Severe heroin-induced pulmonary edema occurred in three previously healthy young men. Adequate arterial PO2 could only be achieved with the use of positive endexpiratory pressure (PEEP). Recovery was characterized by the gradual clearing of the pulmonary infiltrates and a gradual lessening of the severe restrictive ventilatory defects over many weeks. Concomitant aspiration of gastric acid was thought to be the explanation for the severity of these cases. In cases such as these, initial vigorous therapy, including PEEP for hypoxia, corticosteroids for possible aspiration and volume replacement for hypotension, is recommended.

Topics: Adrenal Cortex Hormones; Adult; Gastric Juice; Heroin; Humans; Hypotension; Hypoxia; Inhalation; Male; Positive-Pressure Respiration; Pulmonary Edema; Vital Capacity

Topics: Adult; Aneurysm; Brain; Ganglia, Spinal; Globus Pallidus; Heroin; Humans; Hypotension; Infarction; Male; Morphine Dependence; Muscular Atrophy; Necrosis; Peripheral Nerves; Spinal Cord

Topics: Acute Kidney Injury; Adult; Ammonia; Antitussive Agents; Chloroform; Chromatography, Thin Layer; Cocaine; Cyclizine; Heroin; Humans; Hypotension; Ketones; Male; Methods; Morphine; Pharmaceutical Preparations; Substance-Related Disorders