{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T17:36:50Z","timestamp":1763746610840,"version":"3.38.0"},"reference-count":18,"publisher":"American Veterinary Medical Association (AVMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["javma"],"published-print":{"date-parts":[[2007,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n<jats:p><jats:bold>Case Description<\/jats:bold>\u2014A healthy 6-year-old 28.5-kg (62.7-lb) spayed female Boxer undergoing surgical repair of a ruptured cranial cruciate ligament was inadvertently administered an overdose of morphine (1.3 mg\/kg [0.59 mg\/lb]) via subarachnoid injection.<\/jats:p>\n<jats:p><jats:bold>Clinical Findings<\/jats:bold>\u201450 minutes after administration of the overdose, mild multifocal myoclonic contractions became apparent at the level of the tail; the contractions migrated cranially and progressively increased in intensity and frequency during completion of the surgery.<\/jats:p>\n<jats:p><jats:bold>Treatment and Outcome<\/jats:bold>\u2014The myoclonic contractions were refractory to treatment with midazolam, naloxone, phenobarbital, and pentobarbital; only atracurium (0.1 mg\/kg [0.045 mg\/lb], IV) was effective in controlling the movements. The dog developed hypertension, dysphoria, hyperthermia, and hypercapnia. The dog remained anesthetized and ventilated mechanically; treatments included continuous rate IV infusions of propofol (1 mg\/kg\/h [0.45 mg\/lb\/h]), diazepam (0.25 mg\/kg\/h [0.11 mg\/lb\/h]), atracurium (0.1 to 0.3 mg\/kg\/h [0.045 to 0.14 mg\/lb\/h]), and naloxone (0.02 mg\/kg\/h [0.009 mg\/lb\/h]). Twenty-two hours after the overdose, the myoclonus was no longer present, and the dog was able to ventilate without mechanical assistance. The dog remained sedated until 60 hours after the overdose, at which time its mentation improved, including recognition of caregivers and response to voice commands. No neurologic abnormalities were detectable at discharge (approx 68 hours after the overdose) or at a recheck evaluation 1 week later.<\/jats:p>\n<jats:p><jats:bold>Clinical Relevance<\/jats:bold>\u2014Although intrathecal administration of an overdose of morphine can be associated with major and potentially fatal complications, it is possible that affected dogs can completely recover with immediate treatment and extensive supportive care.<\/jats:p>","DOI":"10.2460\/javma.230.11.1665","type":"journal-article","created":{"date-parts":[[2007,6,1]],"date-time":"2007-06-01T13:40:21Z","timestamp":1180705221000},"page":"1665-1668","source":"Crossref","is-referenced-by-count":15,"title":["Intrathecal morphine overdose in a dog"],"prefix":"10.2460","volume":"230","author":[{"given":"Anderson F.","family":"da Cunha","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer E.","family":"Carter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Grafinger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather","family":"Montgomery","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven L.","family":"Marks","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lysa P.","family":"Posner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Burns","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1272","reference":[{"key":"ref1","series-title":"J Pain Symptom Manage","first-page":"51","article-title":"Strychnine-like multifocal myoclonus and seizures in extremely high-dose opioid administration: treatment strategies","volume":"14","author":"Hagen","year":"1997"},{"key":"ref2","series-title":"Adv Neurol","first-page":"545","article-title":"A new animal model for action myoclonus","volume":"43","author":"Shohami","year":"1986"},{"key":"ref3","series-title":"Vet Anaesth Analg","first-page":"257","article-title":"Myoclonus and urinary retention following subarachnoid morphine injection in a dog","volume":"30","author":"Kona-Boun","year":"2003"},{"key":"ref4","series-title":"Br J Anaesth","first-page":"925","article-title":"Intrathecal morphine overdose during combined spinal-epidural block for caesarean delivery","volume":"89","author":"Cannesson","year":"2002"},{"key":"ref5","series-title":"J Pain Symptom Manage","first-page":"74","article-title":"Relationships among morphine metabolism, pain and side effects during long-term treatment: an update","volume":"25","author":"Andersen","year":"2003"},{"key":"ref6","series-title":"Pain","first-page":"337","article-title":"Hyperalgesia and myoclonus with intrathecal infusion of high-dose morphine","volume":"47","author":"De Conno","year":"1991"},{"key":"ref7","series-title":"Brain Res","first-page":"107","article-title":"Opiate alkaloids antagonize postsynaptic glycine and GABA responses: correlation with convulsant action","volume":"236","author":"Werz","year":"1982"},{"key":"ref8","series-title":"Neurol India","first-page":"410","article-title":"Successful treatment of intrathecal morphine overdose","volume":"51","author":"Yilmaz","year":"2003"},{"key":"ref9","series-title":"Br J Pharmacol","first-page":"211","article-title":"Different distribution of morphine and morphine-6 B-glucuronide after intracerebroventricular injection in rats","volume":"140","author":"Okura","year":"2003"},{"key":"ref10","series-title":"Eur J Drug Metab Pharmacokinet","first-page":"166","article-title":"Presence of morphine metabolites in human cerebrospinal fluid after intracerebroventricular administration of morphine.","volume":"Spec No 3","author":"Sandouk","year":"1991"},{"key":"ref11","series-title":"Pharmacol Toxicol","first-page":"197","article-title":"The neuroexcitatory morphine metabolite, morphine-3-glucuronide (M3G), is not neurotoxic in primary cultures of either hippocampal or cerebellar granule neurones","volume":"93","author":"Hemstapat","year":"2003"},{"key":"ref12","series-title":"Anesthesiology","first-page":"936","article-title":"Ventilatory effects of fourth cerebroventricular infusions of morphine-6- or morphine-3-glucuronide in the awake dog","volume":"71","author":"Pelligrino","year":"1989"},{"key":"ref13","series-title":"Acta Anaesthesiol Scand","first-page":"1070","article-title":"Is development of hyperalgesia, allodynia and myoclonus related to morphine metabolism during long-term administration? 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