Medical Pharmacology Chapter 13 Opioids: Advanced Topics

Influence of Opioids on Cardiovascular Dynamics1

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"A comparison of morphine, fentanyl and sufentanil anesthesia for cardiac surgery: induction, emergence, and extubation"

  • An example of the comparative opioid study in the context of cardiac surgery; one that considers induction emergence and extubation is noted below in the work of Sanford et al. (1986).

  • This study compared anesthetic doses of morphine (n = 10), fentanyl (n=9) and sufentanil (n=9) in a group of patients undergoing cardiovascular surgery.  The opioid was administered after induction and took into consideration the EEG as well as cardiovascular signs indicative of anesthesia depth. Opioid comparisons included the following parameters:

    1. Times for anesthesia induction

    2. Return of consciousness

    3. Return of spontaneous ventilation

    4. Return event with cardiovascular status

    5. Extubation.

  • Using a test for significance in which p < 0.05, the following statistically significant shorter times for sufentanil compared to fentanyl or morphine reported as mean +/- standard  error of the mean ( SEM) or reported as follows:

    • Induction: (15 +/- 2.3 minutes, 5.9 +/- 0.7 minutes, 3.0 +/- 0.2 minutes for morphine, fentanyl, and sufentanil respectively.

    • Return of consciousness: morphine 19.7 +/- 34.4 minutes, fentanyl 62.3 +/- 70.9 minutes, sufentanil 17 +/- 8.7 minutes.

    • Return of acceptable and stable cardiac status: morphine 587.3 +/- 139.3 minutes, fentanyl 537.9 +/- 144.8 minutes, sufentanil 173.7 +/- 56.8 minutes.

    • Extubation: morphine 1121.3 +/- 61.8 minutes, fentanyl 1005.7 +/- 77.7 minutes, sufentanil 533.3 +/- 67.8 minutes.

  • The authors concluded that sufentanil administered in the dosage range of 19 g/kg will allow for more rapid induction as well as earlier anesthesia merchants and faster extubation of patients when compared with either morphine or fentanyl.

  • Reference: Sanford, TJ, NT Smith, D Dec-Silver and WK Harrison, A comparison of morphine, fentanyl and sufentanil anesthesia for cardiac surgery: induction, emergence, and extubation Anesthesia & Analgesia, Vol 65, 259-266, 1986

 

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