Pétry T, Cloez O, Pertek J P, Heck M, Auque J
Ann Fr Anesth Reanim. 1985;4(5):424-6. doi: 10.1016/s0750-7658(85)80274-4.
A case of delayed respiratory depression following an intrathecal injection of hyperbaric morphine hydrochloride is reported. This injection was made during a lumbar myelography in a 60 year old patient suffering from metastatic epiduritis unrelieved by oral or parenteral drugs. The differences in densities between the CSF, hyperbaric opiate solution and contrast medium explain the migration of the morphine hydrochloride from the lumbar thecal space to the basal cisternae, giving a fall in the responsiveness to CO2 of the brain stem respiratory centres. Parenteral naloxone did not reverse this ventilatory depression. Only the myosis and the analgesia disappeared. After 16 h of various attempts of reversal by parenteral injections, an intrathecal injection of naloxone was tried. This small dose (0.1 mg), given intrathecally, resulted in a prompt return to normal of respiratory function.
本文报告了1例鞘内注射高比重盐酸吗啡后出现延迟性呼吸抑制的病例。该注射是在一位60岁患有转移性硬脊膜炎的患者进行腰椎脊髓造影时进行的，该患者口服或胃肠外给药均无法缓解症状。脑脊液、高比重阿片溶液和造影剂之间的密度差异解释了盐酸吗啡从腰段鞘内间隙向脑基底池的迁移，导致脑干呼吸中枢对二氧化碳的反应性下降。胃肠外注射纳洛酮未能逆转这种通气抑制。只有瞳孔缩小和镇痛作用消失。在进行了16小时的各种胃肠外注射逆转尝试后，尝试鞘内注射纳洛酮。鞘内注射的小剂量（0.1mg）纳洛酮使呼吸功能迅速恢复正常。
