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 microg/kg (range 5-24 microg/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.

Right ventricular hemangioma causing right ventricular inflow obstruction and right heart failure.

We report a patient who presented with symptoms of right heart failure. Transesophageal echocardiography revealed a right ventricular mass, causing right ventricular inflow obstruction. Coronary angiography revealed a characteristic tumor blush. After successful surgical resection, histologic findings were consistent with a right ventricular hemangioma.