Some Circulatory and Respiratory Effects of Morphine in Patients Without Pre-Existing Cardiac Disease

Abstract

SUMMARYHaemodynamic and respiratory effects of i.v. morphine (10 mg/70 kg body weight) were studied in 10 adults with unimpaired circulatory function. There were significant changes in mean arterial pressure, mean heart rate, respiratory rate and tidal volume, at 10-, 30-and 60-min intervals. Transient changes in mean total systemic resistance and mean stroke volume were also seen at 10 min. The results strongly suggest a peripheral vasodilator response to morphine. Respiratory depression was not demonstrated.Although opium has been used from antiquity and despite the lack of knowledge of the precise haemodynamic effects of morphine, there are large amounts of data concerning the actions of narcotics on circulation and respiration (Kreuger, Eddy and Sumwalt, 1941;Eddy, Halbach and Braenden, 1957;Reynolds and Randall, 1957). Many published studies show lack of appreciation of the importance of standardization of patient population regarding such factors as their mental and emotional state, physical condition, intensity of pain and type of anaesthesia. In many instances, concomitant respiratory depression secondary to administration of morphine had not been taken into account while assessing the haemodynamic effects. Sufficient attention had not been given to standardization of the dose (in relation to body size), the rate or even the site of injection. Moreover, many studies were undertaken when methods of measuring circulatory and respiratory changes were less accurate than those available today. Results from animal experiments have even been taken to represent a human response, disregarding the species difference.Since a review of published data on the cardiorespiratory effects of morphine failed to reveal a consistent pattern of response, it was felt that a re-evaluation of its cardiovascular effects, under rigidly controlled clinical conditions, would be both relevant and justifiable. The present study, therefore, is to assess the haemodynamic effeas of a clinically used dose (10 mg/70 kg body weight) of morphine, in patients with unimpaired circulatory function. This investigation not only provides a "baseline" for studies on patients with impaired cardiovascular

Combined Cardiopulmonary Assessments Using Impedance and Digital Implants in Conscious Freely Moving Cynomolgus Monkeys, Beagle Dogs, and Göttingen Minipigs: Pharmacological Characterization and Social Housing Effects

“…Morphine is known to have different side effects, the one most recognized being the dose-dependent respiratory depression, whereas it is usually associated with relatively limited cardiovascular effects. 14 In NHPs, a long-lasting reduction in MV was observed reaching statistical significance at one time-point, that is, 5.50 hours following treatment. Morphine also decreased BP in NHPs, reaching statistical significance at 4.25 and 14.50 hours post-injection.…”

“…Morphine also decreased BP in NHPs, reaching statistical significance at 4.25 and 14.50 hours post-injection. 14,15 In Beagle dogs, morphine had no statistically significant effect on respiratory and cardiovascular parameters, although a trend toward lower RR values was observed. This observation is somewhat unexpected as morphine administration in dogs has been shown to induce respiratory depression in this species.…”

The influence of drugs used for sedation during mechanical ventilation on respiratory pattern during unassisted breathing and assisted mechanical ventilation: a physiological systematic review and meta-analysis

“…2 ). There was no statistically significant association between medication administration and change in tidal volume for opioids (11% decrease, 95% CI 28% decrease-5% increase, 6 arms) 39 , 55 , 56 and other hypnotic agents (9% decrease, 95% CI 23% decrease-6% increase, 6 arms) 23 , 36 , 41 , 44 , 49 ( Fig. 2 ).…”

“…A total of 44 studies with 56 arms reported respiratory rate in patients breathing without mechanical ventilation. Opioids were associated with a statistically significant mean reduction in respiratory rate of 18% (95% CI 12–24%, p < 0.0001, 24 arms), 15 , 20 , 21 , 33 , 35 , 39 , 46 , 51 , 55 , 56 , 61 , 62 , 65 whereas inhaled sevoflurane was associated with an increase in respiratory rate of 83% (95% CI 49–118%, p < 0.0001, 1 arm). 28 Mean percent changes in respiratory rate were close to zero and not statistically significant with exposure to benzodiazepines (2% decrease, 95% CI 9% decrease-6% increase, 16 arms), 19 , 26 , 27 , 29 , 37 , 42 , 43 , 47 , 50 , 59 , 63 , 64 other hypnotic agents (2% decrease, 95% CI 9% decrease-5% increase, 17 arms), 17 , 23 , 26 , 29 , 30 , 31 , 32 , 34 , 36 , 41 , 44 , 48 , 49 , 59 and propofol (4% increase, 6% decrease-14% increase, 9 arms) 16 , 17 , 30 , 41 , 52 , 54 , 60 , 61 , 63 ( Fig.…”