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Ventilatory effects of morphine, pethidine and methadone in children
1Department of Ophthalmology, University of Helsinki, Finland.
Insights
This study compared the ventilatory effects of morphine, pethidine, and methadone in children after eye surgery. Methadone and pethidine caused greater acute decreases in breathing rate and oxygen saturation than morphine.
Area of Science:
- Anesthesiology
- Pediatric Pharmacology
- Respiratory Physiology
Background:
- Opioid analgesics are commonly used for postoperative pain management in children.
- Understanding the specific ventilatory effects of different opioids is crucial for safe pediatric anesthesia.
Purpose of the Study:
- To compare the ventilatory effects of single intravenous doses of morphine, pethidine, and methadone in children undergoing ophthalmic surgery.
- To characterize the distinct ventilatory profiles and duration of effects for each opioid.
Main Methods:
- An open, randomized study involving 30 children aged 3-8 years.
- Administration of single intravenous doses: morphine 0.1 mg/kg, pethidine 0.67 mg/kg, and methadone 0.1 mg/kg.
- Monitoring of ventilatory frequency, oxygen saturation, and end-tidal carbon dioxide and oxygen concentrations.
Main Results:
- Pethidine and methadone caused a greater acute decrease in ventilatory frequency compared to morphine.
- Methadone and pethidine resulted in a more significant acute decrease in oxygen saturation than morphine.
- Methadone led to a prolonged increase in end-tidal carbon dioxide and decrease in end-tidal oxygen compared to morphine and pethidine.
- Ventilatory changes were most transient with pethidine and longest-lasting with methadone.
- No cases of apnea or hypoventilation requiring assistance were observed.
Conclusions:
- Morphine, pethidine, and methadone exhibit distinct ventilatory profiles in pediatric patients post-ophthalmic surgery.
- Methadone demonstrates the most prolonged impact on ventilation, while pethidine's effects are more transient.
- All studied opioids were safely tolerated without significant respiratory compromise in this pediatric cohort.
Abstract:
The ventilatory effects of single i.v. doses of morphine 0.1 mg kg-1, pethidine 0.67 mg kg-1 and methadone 0.1 mg kg-1 were compared after ophthalmic surgery in an open, randomized study in 30 children aged 3-8 yr. Ventilatory changes after each drug had distinctive profiles, with appreciable individual variation. Acutely, the decrease in ventilatory frequency was greater with pethidine and methadone than with morphine. The acute decrease in oxygen saturation was greater with methadone and pethidine than with morphine. Methadone produced a greater and longer lasting increase in end-tidal carbon dioxide and greater decrease in end-tidal oxygen than morphine or pethidine. Changes in end-tidal carbon dioxide and oxygen concentrations and saturation were most transient after pethidine and of longest duration after methadone. No child developed apnoea or hypoventilation requiring assistance.