| Opioids and cardioprotection: the impact of morphine and fentanyl on recovery of ventricular function after cardiopulmonary bypass. | |
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MedLine Citation:
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PMID: 16884978 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Experimental studies have shown that opioids protect the myocardium from ischemic injury and that opioid cardioprotection is enhanced by the coadministration of volatile anesthetics. Previous data suggest that morphine produces a more potent cardioprotective effect than fentanyl. The present study investigated the effect of the choice of intraoperative opioid (morphine or fentanyl) on recovery of myocardial function after coronary artery bypass graft (CABG) surgery. DESIGN: Prospective, randomized study. SETTING: University hospital. PARTICIPANTS: Forty-six patients undergoing CABG surgery. INTERVENTIONS: Patients were randomly assigned to receive either morphine (40 mg) or fentanyl (1,000 mug) before cardiopulmonary bypass (CPB). Global cardiac function was assessed intraoperatively using the myocardial performance index (MPI), which combines echocardiographic parameters of both systolic and diastolic function. MEASUREMENTS AND MAIN RESULTS: The MPI (median [range]) was increased after CPB in the fentanyl group, indicating a significant worsening of global left ventricular function (0.43 [0.28-0.54] baseline; 0.49 [0.32-0.64] 15 minutes post-CPB; 0.51 [0.36-0.63] end of operation; p < 0.05 post-CPB compared with baseline). The MPI improved in the morphine group after CPB (0.44 [0.32-0.64] baseline; 0.36 [0.24-0.45] 15 minutes post-CPB; 0.34 [0.20-0.46] end of operation; p < 0.05 post-CPB compared with baseline and the fentanyl group). CONCLUSIONS: In patients undergoing CPB, global ventricular function is enhanced by the administration of morphine prior to the ischemic insult of cardioplegic arrest. |
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Authors:
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Glenn S Murphy; Joseph W Szokol; Jesse H Marymont; Michael J Avram; Jeffery S Vender |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial Date: 2006-01-27 |
Journal Detail:
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Title: Journal of cardiothoracic and vascular anesthesia Volume: 20 ISSN: 1053-0770 ISO Abbreviation: J. Cardiothorac. Vasc. Anesth. Publication Date: 2006 Aug |
Date Detail:
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Created Date: 2006-08-03 Completed Date: 2007-01-11 Revised Date: 2008-11-21 |
Medline Journal Info:
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Nlm Unique ID: 9110208 Medline TA: J Cardiothorac Vasc Anesth Country: United States |
Other Details:
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Languages: eng Pagination: 493-502 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology, Evanston Northwestern Healthcare, Northwestern University Feinberg School of Medicine, Evanston, IL 60201, USA. gmurphy@enh.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Analgesics, Opioid / pharmacology* Anesthetics, Intravenous / pharmacology* Cardiopulmonary Bypass* Cardiovascular Physiological Phenomena Coronary Artery Bypass Double-Blind Method Echocardiography Female Fentanyl / pharmacology* Humans Ischemic Preconditioning, Myocardial* Male Morphine / pharmacology* Myocardial Reperfusion Injury / physiopathology, prevention & control, ultrasonography Natriuretic Peptide, Brain / blood Troponin I / blood Ventricular Function* Ventricular Function, Left / drug effects* |
| Chemical | |
Reg. No./Substance:
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0/Analgesics, Opioid; 0/Anesthetics, Intravenous; 0/Troponin I; 114471-18-0/Natriuretic Peptide, Brain; 437-38-7/Fentanyl; 57-27-2/Morphine |
| Comments/Corrections | |
Comment In:
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J Cardiothorac Vasc Anesth. 2007 Jun;21(3):474-5; author reply 475-6
[PMID:
17544914
]
J Cardiothorac Vasc Anesth. 2006 Aug;20(4):473-6 [PMID: 16884975 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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