Morphine pharmacokinetics in children following cardiac surgery: Effects of disease and inotropic support

Ovadia Dagan, Julia Klein, Desmond Bohn, Geoffrey Barker, Gideon Koren*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


The pharmacokinetics of morphine have not been previously studied in children following cardiac surgery for tetralogy of Fallot (TOF) or transposition of the great arteries (TGA). Morphine steady-state pharmacokinetics were studied in 21 children undergoing repair of TOF, TGA, or atrio-ventricular septal defects (AVSD). Children with TOF or TGA had increased right-sided pressures with no differences between the groups. Children with TOF had significantly faster clearance rates of morphine (1.39 ± 0.37 L/kg/h) than children following the Fontan procedure (0.86 ±0.31 L/kg/h, P < 0.01). When stratifying children by their postsurgical needs for Inotropic support, those needing epinephrine, dopamine, or dobutamine at more than 10 Wg/kg/min had significantly slower clearance rates (0.73 ± 0.3 L/ kg / h) when compared to the rest of the patients (1.5 ± 0.41 L/kg/h, P < 0.05). Because most children needing Inotropic support underwent the Fontan procedure, it is conceivable that their cardiovascular status had a major impact on morphine metabolism. These results suggest a 50% reduction in morphine dosage in children requiring Inotropic support following cardiac surgery.

Original languageEnglish
Pages (from-to)396-398
Number of pages3
JournalJournal of Cardiothoracic and Vascular Anesthesia
Issue number4
StatePublished - Aug 1993
Externally publishedYes


  • morphine
  • tetralogy of Fallot
  • transposition of great arteries


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