AboutNigel Simmons Expertise I am happy to answer general questions on medicines and hospital care. If possible, please use approved / chemical names rather than brands which are not internationally recognised.
Like all health professionals I am bound by a duty of care which prevents me giving detailed information about medication or treatment of people other than the questioner.
I will endeavour to help wherever possible or point towards more appropriate advice. If however your question crosses too far into patient confidentiality, I hope you will understand why I cannot answer your question.
Consider.. would you want me to discuss your care with a friend or relative without your knowledge?
Experience Registered as a UK pharmacist in 1982 and have worked in a number of hospital and health management posts around the UK. Formerly Chief Pharmacist for a 440 bed general hospital in Cambridgeshire.
Past/Present clients Previously Sysop on CompuServe UK Professionals forum.
Question I'm going to try to make this short, but it is complicated. My 90-yr-old Dad has not been eating well and has lost lots of weight in the last 3-4 mths. After a recent endoscopy by a GI, he was told that, among other problems, he has a hiatal hernia that is the largest one the doctor has ever seen--possibly there and growing since birth--but it has never been diagnosed before (nor has it ever given him any problems), and it has recently caused him lots of problems. Long before this was discovered, it was determined that he has COPD (has never smoked) and Interstitial Lung Disease. He also has a pacemaker and has had an angioplasty.
The GI said there were a couple of things he could try but because of the COPD and the ILD, he didn't think my dad would survive an operation. He finally decided to contact a surgeon and consult with him about it, and the surgeon decided he would try 3 things: 1) pull down the portion (about 25%) of his stomach that was protruding through his diaphragm and stitch it in place closer to where it belongs; 2) insert a J-tube to feed him (an earlier attempt this week at inserting a G-tube was unsuccessful due to the hernia); and 3) try to repair the hernia (this last attempt was ultimately unsuccessful). The first two procedures went well, and he didn't have any distress during the operation. Since the operation (which was completed Friday night around 6:30 p.m.), his vital signs have been amazingly good with BP at 115/58 on Saturday and 135/63 on Sunday, heart rate at 75 to 85, and blood saturation at 97 to 100. They wanted him off the respirator ASAP and were able to take him off of it at 8:30 p.m. Friday night.
After all that background, my question is this: he was given morphine for the operation (which I have read everywhere is not recommended to be used on a patient with COPD), and he has still not woken up since the operation.
I have looked everywhere on the Internet and I have been unable to find anything that says how long it might take for it to wear off for someone with his many complications. I have, however, read many things that said it may even be contraindicated to give morphine to a patient with COPD. While I was really encouraged about how good his vital signs are, I'm very concerned about what I keep reading about COPD and Morphine. Can you give me any guidance in this area? If all goes well, is it out of line to think it might be sometime Monday before he even begins to wake up? As you can imagine, my mother is very anxious at this point. Please help!
Answer Bonnie
Firstly you need to remember that your father has been throgh what for someone with his history and age is very major surgery.
If as you say your father is now off the ventilator and is breathing spontaneously, then it is unlikley that the morphine has depressed the respiratory control area in his brain. This is the reason why morphine is usually avoided in COPD patients.
I'm not experienced enough in intensie care medicine to predict how long it will take for your father to regain consciousness. Reducing the morphine dose may help, but the doctors will want to keep him pain free, because this will only place more strain on his frail system. However there will be other medications that also need to be eliminated from his system, and these may be a factor.
I would expect the doctors and nurses will be carrying out regular neurological examinations - checking reflexes, responses to stimuli etc. This will give them the best indication of whether his consciousness is increasing.
Regrettably, there is also a possibility that your father may not have survived the surgery unharmed and may therefore never fully revcover. Breathing is a very reflex process and so while part of the brain may be damaged, other parts can continue to function. You may need to prepare yourself for this and discuss it with the doctors before speaking to your mother.
