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The pharmacokinetics of morphine have not been previously significantly slower clearance rates (0.73 + 0.3 L/kg/h) when
studied in children following cardiac surgery for tetralogy of compared to the rest of the patients (1.5 * 0.41 L/kg/h,
Fallot (TOF) or transposition of the great arteries (TGA). P < 0.05). Because most children needing inotropic support
Morphine steady-state pharmacokinetics were studied in 21 underwent the Fontan procedure, it is conceivable that their
children undergoing repair of TOF, TGA, or atrio-ventricular cardiovascular status had a major impact on morphine metab-
septal defects (AVSD). Children with TOF or TGA had in- olism. These results suggest a 50% reduction in morphine
creased right-sided pressures with no differences between dosage in children requiring inotropic support following
the groups. Children with TOF had significantly faster clear- cardiac surgery.
ance rates of morphine (1.39 f 0.37 L/kg/h) than children Copyright Q 1993 by W.B. Saunders Company
following the Fontan procedure (0.86 f 0.31 L/kg/h,
P < 0.01). When stratifying children by their postsurgical KEY WORDS: morphine, tetralogy of Fallot, transposition of
needs for inotropic support, those needing epinephrine, great arteries
dopamine, or dobutamine at more than 10 pg/kg/min had
Table 1. Comparison Between Children Following TOF and Table 3. Morphine Pharmacokinetics
Fontan Repair
Ke (h - 1) VD (L/kg) CL (L/kg/h) t%(h)
Fontan TOF
1 0.144 10.25 1.32 6.5
RA Morphine RA Morphine 2 0.102 13.1 1.28 11.5
Patient PWSSlre ClearalICe Patient PR?SSUW CleWSlC2
3 0.066 10.3 0.76 5.5
NO. (cm HzO) (L/kg/h) NO. (cm H,Ol (L/kg/h)
4 0.097 8.3 0.78 11.5
1 10 1.32 1 12 1.42 5 0.137 4.2 0.53 5.5
2 8 1.28 2 14 1.92 6 0.0589 20.6 1.42 6.5
3 17 0.50 3 14 1.03 7 0.0706 23.2 1.92 7
4 8 0.76 4 10 1.28 8 0.0531 14.8 1.03 3.3
5 8 0.78 5 14 1.06 9 0.134 10.9 1.28 3.3
6 14 0.72 6 13 1.16 0.096 ? 0.036 12.9 + 5.9 1.15 + 0.42 6.7 5 3
7 15 0.53 7 7 2.00
NOTE. Included in this table are only children in whom samples
8 14 0.96 8 14 1.24
during the elimination phase (after cessation of morphine infusion)
Mean 11.7 & 3.7 0.86* -t 0.31 12.3 + 2.6 1.39* + 0.37
were available.
*P < 0.01.
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