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Effects of extracorporeal membrane oxygenation on morphine pharmacokinetics in infants
1Department of Critical Care, Hospital for Sick Children, Toronto, ON, Canada.
Insights
Extracorporeal membrane oxygenation (ECMO) significantly alters morphine pharmacokinetics in infants. Higher morphine doses may be needed post-ECMO to ensure adequate sedation and manage potential withdrawal symptoms.
Area of Science:
- Pediatric critical care medicine
- Pharmacology
- Neonatology
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for critically ill infants.
- Morphine is commonly used for sedation in these patients.
- The impact of ECMO on drug pharmacokinetics, including morphine, is not fully understood.
Purpose of the Study:
- To investigate the pharmacokinetic changes of morphine in infants undergoing ECMO.
- To determine the effect of ECMO on morphine clearance rates.
- To inform optimal morphine dosing strategies in infants treated with ECMO.
Main Methods:
- Prospective, comparative study design.
- Inclusion of seven infants (1 day to 12 months) requiring ECMO.
- Morphine pharmacokinetics assessed during and after ECMO therapy.
Main Results:
- Morphine plasma clearance rate significantly increased after ECMO discontinuation (0.574 L/kg/hr to 1.058 L/kg/hr, p < .01).
- Two infants exhibited signs of opioid withdrawal.
- Steady-state morphine concentrations were used to calculate clearance.
Conclusions:
- ECMO influences morphine pharmacokinetics in infants.
- Increased morphine dosage may be necessary post-ECMO for effective sedation.
- Monitoring for opioid withdrawal is crucial in infants after ECMO therapy.
Objectives:
To study the effect of extracorporeal membrane oxygenation (ECMO) on the pharmacokinetics of morphine in infants.
Design:
A prospective, comparative study of morphine pharmacokinetics during and after ECMO.
Setting:
The pediatric intensive care unit at a children's hospital.
Patients:
Seven infants, aged 1 day to 12 months, requiring ECMO.
Intervention:
Infusion of morphine.
Measurement And Main Results:
Steady-state concentrations of morphine were used to generate a morphine clearance rate. Plasma clearance rate of morphine increased from 0.574 +/- 0.3 L/kg/hr to 1.058 +/- 0.727 L/kg/hr after discontinuation of ECMO (p < .01). Two infants experienced a clinical picture consistent with opioid withdrawal.
Conclusion:
Infants requiring morphine after ECMO may require higher dose rates to maintain adequate sedation.