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Original article| Volume 7, ISSUE 4, P396-398, August 1993

Morphine pharmacokinetics in children following cardiac surgery: Effects of disease and inotropic support

  • Ovadia Dagan
    Affiliations
    From the Division of Clinical Pharmacology, Departments of Pediatrics and Critical Care, and Research Institute, The Hospital for Sick Children, Toronto, Department of Pediatrics, Pharmacology, and Anesthesia, The University of Toronto Canada
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  • Julia Klein
    Affiliations
    From the Division of Clinical Pharmacology, Departments of Pediatrics and Critical Care, and Research Institute, The Hospital for Sick Children, Toronto, Department of Pediatrics, Pharmacology, and Anesthesia, The University of Toronto Canada
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  • Desmond Bohn
    Affiliations
    From the Division of Clinical Pharmacology, Departments of Pediatrics and Critical Care, and Research Institute, The Hospital for Sick Children, Toronto, Department of Pediatrics, Pharmacology, and Anesthesia, The University of Toronto Canada
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  • Geoffrey Barker
    Affiliations
    From the Division of Clinical Pharmacology, Departments of Pediatrics and Critical Care, and Research Institute, The Hospital for Sick Children, Toronto, Department of Pediatrics, Pharmacology, and Anesthesia, The University of Toronto Canada
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  • Gideon Koren
    Correspondence
    Address reprint requests to Gideon Koren, MD, ABMT FRCP(C), Division of Clinical Pharmacology, The Hospital for Sick Children, 555 UniversityAve, Toronto, Ontario, M5G 1X8.
    Affiliations
    From the Division of Clinical Pharmacology, Departments of Pediatrics and Critical Care, and Research Institute, The Hospital for Sick Children, Toronto, Department of Pediatrics, Pharmacology, and Anesthesia, The University of Toronto Canada
    Search for articles by this author
DOI:https://doi.org/10.1016/1053-0770(93)90158-H
Morphine pharmacokinetics in children following cardiac surgery: Effects of disease and inotropic support
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      Abstract

      The pharmacokinetics of morphine have not been previously studied in children following cardiac surgery for tetralogy of Fallot (TOF) or transposition of the great arteries (TGA). Morphine steady-state pharmacokinetics were studied in 21 children undergoing repair of TOF, TGA, or atrio-ventricular septal defects (AVSD). Children with TOF or TGA had increased right-sided pressures with no differences between the groups. Children with TOF had significantly faster clearance rates of morphine (1.39 ± 0.37 L/kg/h) than children following the Fontan procedure (0.86 ±0.31 L/kg/h, P < 0.01). When stratifying children by their postsurgical needs for Inotropic support, those needing epinephrine, dopamine, or dobutamine at more than 10 Wg/kg/min had significantly slower clearance rates (0.73 ± 0.3 L/ kg / h) when compared to the rest of the patients (1.5 ± 0.41 L/kg/h, P < 0.05). Because most children needing Inotropic support underwent the Fontan procedure, it is conceivable that their cardiovascular status had a major impact on morphine metabolism. These results suggest a 50% reduction in morphine dosage in children requiring Inotropic support following cardiac surgery.

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      DOI: https://doi.org/10.1016/1053-0770(93)90158-H

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      © 1993 Published by Elsevier Inc.

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