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Postoperative morphine concentration in infants with or without biliary atresia and its association with hepatic
1Department of Anesthesiology, Children's Hospital of Fudan University, Shanghai, China.
Insights
Infants with biliary atresia maintain normal hepatic blood flow through compensatory arterial flow. Postoperative morphine concentrations were similar between infants with and without biliary atresia, with an inverse relation to hepatic perfusion.
Area of Science:
- Pediatric Surgery
- Hepatology
- Pharmacokinetics
Background:
- Biliary atresia is a severe neonatal liver disease requiring surgical intervention.
- Hepatic blood flow is critical for drug metabolism and organ function.
- Understanding drug pharmacokinetics in infants with liver disease is essential for safe and effective treatment.
Purpose of the Study:
- To compare pre-operative hepatic blood flow in infants with and without biliary atresia.
- To assess postoperative morphine concentrations in these infant groups.
- To investigate the relationship between hepatic blood flow and morphine pharmacokinetics.
Main Methods:
- Magnetic resonance imaging (MRI) was used to assess hepatic blood flow in infants undergoing portoenterostomy (Kasai operation) and controls.
- Intravenous morphine infusion was administered postoperatively to all infants.
- Morphine concentrations were measured after 24 hours of infusion.
Main Results:
- No significant difference in relative hepatic blood flow was observed between infants with and without biliary atresia (p = 0.851).
- Postoperative morphine concentrations at 24 hours were comparable between the two groups (p = 0.460).
- A significant inverse regression relationship was found between morphine concentration and the hepatic perfusion index (R(2) = 0.519, p = 0.001).
Conclusions:
- Infants with biliary atresia demonstrate compensatory increases in hepatic arterial blood flow, maintaining overall hepatic blood flow.
- Hepatic blood flow does not significantly impact morphine concentrations in the early postoperative period in this cohort.
- The findings suggest that hepatic perfusion plays a role in morphine disposition, warranting further investigation.
Abstract:
We measured pre-operative hepatic blood flow and postoperative morphine concentration in infants with or without biliary atresia. Thirty-four infants (0-3 months) with biliary atresia undergoing portoenterostomy (Kasai operation) were included and hepatic blood flow was assessed by magnetic resonance imaging before surgery in 12 of them. Sixteen subjects (0-3 months) without liver disease undergoing abdominal or pelvic surgery acted as controls and six of them had hepatic blood flow assessed. Intravenous morphine (8 μg.kg(-1).h(-1)) was administered to all patients postoperatively. The median (IQR [range]) relative hepatic blood flow was 3.51 (2.72-3.88 [1.68-4.43]) with and 3.15 (2.66-4.42 [2.30-5.01]) without biliary atresia (p = 0.851). The median (IQR [range]) morphine concentration after 24 h infusion was 5.9 (4.5-16.4 [2.9-42.2]) ng.ml(-1) and 6.4 (3.2-12.0 [1.9-48.6]) ng.ml(-1) , respectively (p = 0.460). An inverse regression relation was found between the morphine concentration and the hepatic perfusion index (R(2) = 0.519, p = 0.001). Compensatory increases in hepatic arterial blood flow maintain the total hepatic blood flow in infants with biliary atresia.
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