Cardiorespiratory Effects of Anaesthesia With Morphine or Fentanyl in Chronic Renal Failure and Cerebral Toxicity After Morphine

Abstract

Three patients with chronic renal failure received fentanyl 0.5 mg and suxamethonium 40 mg intravenously. Vasoactivity attributed to suxamethonium and loss of consciousness were noted. Cardiorespiratory effects of unsupplemented fentanyl 0.5 mg injected slowly were not significant in four chronically azotaemic patients. After morphine 100 mg was administered intravenously over a period of 10 minutes a characteristic fall in arterial oxygen tension was observed to a more pronounced degree than after fentanyl. Carbon dioxide responses were similar. There were no delayed sequelae in the fentanyl recipients. After morphine 100 mg there was a latent period of freedom from clinical side effects for 6 hours in the first and 95 minutes in the second patient, at which times deep coma persisting for 72 hours supervened in both. Lowenstein and his colleagues (1969) have used single intravenous doses of morphine 1 mg/kg and Grell, Koons and Denson (1970) reported on the use of fentanyl 0.5 mg to provide anaesthesia for major surgery. Fentanyl is generally preferred because it is ultra-short-acting in comparison with morphine (Guertner, Doenicke and Spiess, 1964). Finch and DeKornfeld (1967) found that the duration of action of equipotent doses of the two drugs was similar in two postoperative studies in which fentanyl 0.05 mg and 0.2 mg respectively were compared in each instance with morphine 10 mg. We designed an experimental study to compare the duration of measurable effects of fentanyl 0.5 mg and morphine 100 mg in patients with endstage renal disease being treated by haemodialysis. These metabolically deficient patients were chosen because the sparing effects which Lowenstein and associates (1969) noted to be associated with morphine anaesthesia suggested to us that it might be the most suitable anaesthetic for the increasing number of surgical procedures which are being performed in these patients.

Studies on Morphine Disposition: Influence of Renal Failure on the Kinetics of Morphine and Its Metabolites

“…Venous blood samples were collected for up to 24 h, and plasma concentrations of morphine, morphine-3-glucuronide (M3G), and morphine-6-glucuronide (M6G) assayed by a differential radioimmunoassay method. There were no differences between the two groups for morphine elimination half-life (renal failure: 290 min; anaesthetized controls: 286min), or clearance (renal failure: 533 ml min' 1 ; controls 741 ml min' 1 ). However, the volume of distribution at steady state was greater in the control group (241 litre v. 141 litre; P = 0.002).…”

“…The preoperative haemoglobin, plasma urea and creatinine concentrations in the transplant patients were in the ranges 5.8-10.9 g dl" 1 , 9.0-33.9 mmol litre" 1 and 466-911 umol litre" 1 , respectively. Immediate postoperative creatinine clearances in the transplant patients were between 36 and 138 ml min" 1 .…”

Molecular mechanism and candidate biomarkers of morphine for analgesia and addiction effects

“…Molecular mechanism and candidate biomarkers of morphine for analgesia and addiction effects However, with the inappropriate use of morphine, its side effects are also becoming apparent. For example, excessive dosage of morphine may lead to hypotension, bradycardia, and respiratory failure (4). Patients with advanced cancer require increased frequency and dose of medication to achieve pain relief (4).…”

“…For example, excessive dosage of morphine may lead to hypotension, bradycardia, and respiratory failure (4). Patients with advanced cancer require increased frequency and dose of medication to achieve pain relief (4). Long-term irregular use of morphine can result in serious dependence, which can lead to addiction (5).…”

Myocardial Sparing Effect of Fentanyl During Halothane Anaesthesia in Dogs

“…The cardiac effects of fentanyl are considered to be less depressant than those of other narcotics such as morphine (Mostert et al, 1971) and meperidine (Freye, 1974). While the respiratory effects of fentanyl have been well documented, there is no available data to allow comparison of depression of respiration with other side effects of this powerful narcotic.…”