Intrathecal morphine for off-pump coronary artery bypass grafting

Objective: To determine if preinduction intrathecal morphine is associated with successful intraoperative extubation in patients undergoing off-pump coronary artery bypass grafting. Design: A retrospective noncontrolled chart review of all patients undergoing off-pump coronary artery bypass grafting. Setting: Single university hospital. Participants: One hundred twelve patients. Interventions: One hundred twelve of 150 patients received preinduction intrathecal morphine as part of routine anesthetic care for off-pump coronary artery bypass grafting. Patients received a mean of 1.0 mg of intrathecal morphine (range 0.3-1.6 mg); average weight-corrected dose was 13.2 mug/kg (range 5-24 mug/kg). Measurements and Main Results: This study included intraoperative extubation rate, delayed respiratory depression, and other complications potentially attributable to intrathecal morphine. An intraoperative extubation rate of 77% was found. Five patients received naloxone postoperatively, 4 of them for delayed respiratory depression. Conclusions: It is concluded that intrathecal morphine is associated with a high intraoperative extubation rate in patients undergoing off-pump coronary artery bypass grafting. The authors' practice included 24-hour respiratory monitoring to detect delayed respiratory depression. (C) 2004 Elsevier Inc. All rights reserved.