Related Experiment Videos
Morphine pharmacokinetics during continuous infusion of morphine sulfate for infants receiving extracorporeal
J M Geiduschek1, A M Lynn, S L Bratton
1Department of Anesthesiology, University of Washington School of Medicine, Children's Hospital and Medical Center, Seattle 98105, USA.
Objectives:
To determine a) if serum morphine concentration changes during the first 3 hrs of extracorporeal membrane oxygenation (ECMO); and b) if absorption of morphine onto the membrane oxygenator is responsible for these changes. Also, morphine clearance during the first 5 days of ECMO was studied.
Design:
Prospective, open-label study with consecutive patient enrollment.
Setting:
Neonatal intensive care unit at a university-affiliated, children's hospital.
Subjects:
Eleven neonates with severe persistent pulmonary hypertension of the newborn receiving continuous intravenous infusions of morphine sulfate and requiring ECMO.
Interventions:
Blood samples were obtained from the subjects and ECMO circuits at predetermined time intervals.
Measurements And Main Results:
Serum morphine concentration was determined using high-performance liquid chromatography. Morphine concentrations were no different from baseline at 5 mins, 1 hr, or 3 hrs after beginning ECMO. There was no significant difference in morphine concentration from samples taken immediately proximal and distal to the membrane oxygenator at 5 mins, 1 hr, and 3 hrs after the start of ECMO. Morphine clearance was calculated on days 1, 3, and 5 of ECMO. The mean value for morphine clearance was 11.7 +/- 9.3 (SD) ml/min/kg (range 2.6 to 34.5).
Conclusions:
The initiation of ECMO does not lead to a significant decrease in serum morphine concentration and there is no uptake of morphine onto the membrane oxygenator of the ECMO circuit. Morphine clearance for infants receiving ECMO is variable.
Insights
Extracorporeal membrane oxygenation (ECMO) does not significantly alter serum morphine levels in neonates. Morphine absorption onto the ECMO membrane oxygenator is not a factor, though morphine clearance during ECMO is variable.
Area of Science:
- Neonatal intensive care
- Pharmacology
- Cardiopulmonary support
Background:
- Continuous intravenous morphine sulfate infusions are used for analgesia in neonates requiring extracorporeal membrane oxygenation (ECMO).
- Understanding morphine pharmacokinetics during ECMO is crucial for optimizing pain management and patient outcomes.
Purpose of the Study:
- To investigate serum morphine concentration changes during the initial 3 hours of ECMO.
- To assess if morphine absorption onto the membrane oxygenator contributes to concentration changes.
- To determine morphine clearance during the first 5 days of ECMO.
Main Methods:
- Prospective, open-label study involving 11 neonates with persistent pulmonary hypertension receiving ECMO.
- Blood samples collected from subjects and ECMO circuits at set intervals.
- Serum morphine concentrations analyzed via high-performance liquid chromatography.
Main Results:
- Serum morphine concentrations remained stable and did not differ significantly from baseline at 5 minutes, 1 hour, or 3 hours after ECMO initiation.
- No significant difference in morphine concentration was detected between samples proximal and distal to the membrane oxygenator.
- Mean morphine clearance on days 1, 3, and 5 of ECMO varied, with a mean of 11.7 ± 9.3 ml/min/kg.
Conclusions:
- ECMO initiation does not cause a significant decrease in serum morphine concentration.
- Morphine does not appear to be absorbed by the membrane oxygenator in the ECMO circuit.
- Morphine clearance in neonates undergoing ECMO is highly variable.