Post anesthesia and immediate administration of pain medication is a lethal combination that will exacerbate?

Question

respiratory depression???

Answer 1

Yes, but mainly for general anesthesia.

Other forms or anesthesia like those that cause Amnesia don't depress the breathing function; however general anesthesia is the one that is most often used when major pain is involved.  An amnesia anesthesia doesn't lessen the pain it only makes it forgettable.

Anesthesia and some pain medications can both suppress the breathing reflex.  The most common major pain medication is morphine and it is well know for its depression effect on the respiratory depression.

According to Wikipedia:  http://en.wikipedia.org/wiki/Anesthesia

"General anesthesia: "Drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation." Patients undergoing general anesthesia can often neither maintain their own airway nor breathe on their own. While usually administered with inhalational agents, general anesthesia can be achieved with intravenous agents, such as propofol."

According to Wikipedia:  http://en.wikipedia.org/wiki/Morphine

"Morphine (INN) (pronounced /ˈmɔrfiːn/) is a highly potent opiate analgesic drug and is the principal active agent in opium and the prototypical opioid. It is also a natural endocrine product in humans and other animals. Like other opioids, e.g., diacetylmorphine (heroin), morphine acts directly on the central nervous system (CNS) to relieve pain, and at synapses of the nucleus accumbens in particular. Studies done on the efficacy of various opioids have indicated that, in the management of severe pain, no other narcotic analgesic, other than Fentanyl (which has a higher potency, but is shorter acting), is more effective or superior to morphine. Morphine is highly addictive when compared to other substances; tolerance, physical and psychological dependences develop very rapidly...

The following conditions are relative contraindications for morphine:

acute respiratory depression

renal failure (due to accumulation of the metabolite morphine-6-glucuronide)

chemical toxicity (potentially lethal in low tolerance subjects)

raised intracranial pressure, including head injury (exacerbation due pCO2 increases from respiratory depression)."

The last fight that those in the death throws from painful cancer is the fight to battle the pain and to keep breathing.  Their level of morphine has to be controlled very carefully because too much can and often does kill them.

Answer 2

Narcotics are respiratory depressants. But it would be a mistake to overstate the case. Narcotics can be a routine and valuable part of balanced anesthesia itself and should be continued to control pain in the post-operative period. It helps if you know what you're doing, and you're careful about it. That's why people go to recovery instead of straight back to their rooms after surgery.

Answer 3

Duragesic patches are contraindicated in post-operative patients.

Answer 4

It's a rare patient that doesn't get opiates during and after surgery.  We try to get just the right amount of opiate on board before you wake up, but it's hard to get it exact.  Too much and you won't start breathing, not enough and you hurt.

The PACU is a critical care area, and the nurses are very good at titrating opiates to avoid respiratory depression.  Sometimes, though, especially in obese patients, the gases that diffused into the fat tissue slowly diffuse out, and patients can get sort of re-anesthetized.  Add that to some post-op opiates, and you can get respiratory depression that requires intervention.  The nurses are also very good at calling us to intervene when that happens!

Sometimes a little naloxone is needed, sometimes we have to put the breathing tube back in for a while until the patient is more awake.  Every patient is different.

It's only lethal if it's not noticed and taken care of.  Otherwise, it's what we do every day.