Cardiovascular Response to Large Doses of Intravenous Morphine in Man

Lowenstein, Edward; Hallowell, Phillips; Levine, Frederick H.; Daggett, Willard M.; Austen, W. Gerald; Laver, Myron B.

doi:10.1056/nejm196912182812503

Cited by 377 publications

(55 citation statements)

References 11 publications

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“…Dynorphin [1][2][3][4][5][6][7][8][9][10][11][12][13] and D'Ala 2, D-LeuS-enkephalin also reduced plasma noradrenaline concentration and blood pressure in pithed rabbits [28] and ethylketocyclazocine was shown to inhibit the release of noradrenaline from sympathetic neurones innervating the sinus node of the rabbit [29].…”

Section: Discussionmentioning

confidence: 99%

“…When morphine is given into a brachial artery there is no change in forearm blood flow or resistance, suggesting that the action of morphine is central rather than peripheral [2]. In patients with cardiac disease morphine causes a significant rise in cardiac index and stroke volume and a decrease in systemic vascular resistance [3]. Morphine has also been shown to be capable of lowering blood pressure at therapeutic doses [4].…”

mentioning

confidence: 99%

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The cardiovascular and central nervous system effects in the human of U-62066E

Rimoy

Wright

Bhaskar

et al. 1994

Eur J Clin Pharmacol

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The cardiovascular and central nervous system effects of the kappa opioid receptor agonist U-62066E were investigated in ten normal male subjects who received U-62066E or placebo with low or high dose naloxone in a randomized, double blind study. Blood pressure and heart rate in the supine and standing position, plasma adrenaline and noradrenaline, regional Doppler blood velocity indices and psychometric assessments were recorded for 1.25 h before and 6 h following injection. U-62066E caused sedation and dysphoria but no euphoria. Plasma noradrenaline was increased by U62066E when compared with basal levels. This action of U62066E was prevented by high but not low dose naloxone. U-62066E had no significant effect on blood pressure, heart rate or regional blood flow indices in the vessels studied and no effect on plasma adrenaline levels. Since U62066E at a dose known to have marked kappa effects was not found to influence cardiovascular indices our results do not support a major role for kappa opioids in the control of the circulation. However, U62066E may influence noradrenaline release or clearance and cause sedation and psychotomimetic effects.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The cardiovascular and central nervous system effects in the human of U-62066E

Rimoy

Wright

Bhaskar

et al. 1994

Eur J Clin Pharmacol

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“…These changes were not seen in control subjects without cardiac disease or those subjects who received 1.0 mg/kg. The data of Lowenstein et al (1969) in patients with chronically pressure-or volume-stressed hearts showed no evidence of cardiac depression with these high doses of morphine. Experiments by Vasko et al (1966a) on anaesthetized, open-chested dogs maintained on right heart bypass with crushed sinoatrial nodes and fixedrate right atrial pacing showed improved left ventricular function curves, improved myocardial contractile force and augmented left ventricular dp/dt with morphine I mg/kg.…”

Section: Morphinementioning

confidence: 79%

“…This variability is probably due to the different degrees of hypovolaemia, anaemia, hypoxaemia, catecholamine drive, electrolyte disturbance and myocardial dysfunction after cardiopulmonary bypass. In seven patients with aortic valve disease about to undergo aortic valve replacement (Lowenstein et al, 1969) enormous doses of morphine 0.5-1.0 mg/kg given intravenously resulted in significant increases in cardiac index, stroke index, central venous and pulmonary artery BPs and a significant decrease in systemic vascular resistance. These changes were not seen in control subjects without cardiac disease or those subjects who received 1.0 mg/kg.…”

Section: Morphinementioning

confidence: 97%

“…The opium alkaloids are histamine liberators, eliciting the triple response when injected in human skin, but this is probably not the sole mechanism of vasodilatation for there is also evidence of a depressor effect on the vasomotor centre (Reynolds & Randall, 1975). Rapid injection, large doses and hypoxaemia accentuate the hypotensive effect, which may then become manifest even in the supine subject (Lowenstein et al, 1969;Wood-Smith et al, 1973). When hypotension does occur, it can be reversed by postural adjustments, blood volume expansion or vasoactive agents (Lowenstein et al, 1969;Wood-Smith et al, 1973).…”

Section: Morphinementioning

confidence: 99%

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Pharmacological and clinical importance of narcotic antagonists and mixed antagonists‐use in cardiology.

Coltart¹,

Malcolm²

1979

Brit J Clinical Pharma

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1 The treatment of pain of cardiac origin requires a knowledge of the haemodynamic action of the analgesic agents used. 2 The haemodynamic effects of morphine, diamorphine, pavaveretum, pethidine and pentazocine are reviewed. 3 Clinical experience with the new antagonist analgesic buprenorphine is reported. 4 These studies indicate that buprenorphine may be the agent of choice for the relief of severe pain in patients with unstable circulation.

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Bradycardic Rhythms During Peritoneal Dialysis

Rutsky¹

1971

Arch Intern Med

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Peri toneal dialysis has been utilized extensively in the management of patients with acute and chronic renal failure and in acute drug intoxication. Although many of the hazards of this procedure have been discussed in detail,1-6 the occurrence of vagal-induced bradycardia and hypotension have been mentioned only briefly.2,7,8 That serious and life-threatening arrhythmias may be produced by peritoneal dialysis-induced vagotonia has not been emphasized. This report stresses the potentially serious nature of such arrhythmias observed during the performance of peritoneal dialysis in three patients. Patient Summaries Patient 1.\p=m-\A54-year-old woman was admitted to the Portsmouth Naval Hospital in December 1969 following the onset of pericarditis associated with chronic renal failure. Physical examination showed the blood pressure to be 136/92 mm Hg and the pulse rate, 94 beats per minute. Moderate cardiomegaly and a typical three-component pericardial friction rub were present. Pitting edema was present in the lower extremities. The blood urea nitrogen (BUN) value was 58 mg/100 ml and the serum creatinine value, 8.0 mg/100 ml. An electrocardiogram demon¬ strated increased left ventricular voltage and nonspecific ST-segment changes. The chest roentgenogram showed generalized cardiomegaly.Peritoneal dialysis was performed via a stylet catheter. The procedure, which was uneventful, was repeated ten days later.The serum electrolyte level was normal at that time. Incomplete drainage of dialysate from the abdomen led to progressive abdominal distention during the second dialysis. While the dialysis catheter was being repositioned, the patient complained of abdominal pain and became cyanotic and acutely short of breath. Concomitantly, the radial pulse decreased from 80 to 15 beats per minute and be¬ came irregular. Intravenous adminis¬ tration of 0.5 mg of atropine sulfate accel¬ erated the pulse rate to 100 beats per minute within 30 seconds. An electro¬ cardiogram subsequently demonstrated a sinus tachycardia. The results of physical examination and the chest roentgenogram were unchanged. The dialysis was contin¬ ued, after replacement of the catheter, without any immediate cardiac ar¬ rhythmia. The patient suffered a cardiac arrest later that day and died. No evi¬ dence of a myocardial infarction or pul¬ monary embolus was found at post¬ mortem examination. The heart was en¬ larged and revealed fibrinous pericarditis and moderate focal coronary arterio¬ sclerosis. Patient 2.-A 19-year-old woman was admitted to the Portsmouth Naval Hospi¬ tal in February 1970 because of abdominal pain and intractable vomiting. Physical examination showed the blood pressure to be 142/92 mm Hg and the pulse rate, 94 beats per minute. Extensive exudates were present in the optic fundi. The re¬ sults of the remainder of the examination were unremarkable. At the time of admis¬ sion the BUN value was 107 mg/100 ml and the serum creatinine level was 16 mg/100 ml.Peritoneal dialysis was performed twice using a stylet catheter. Following the s...

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Cardiovascular Response to Large Doses of Intravenous Morphine in Man

Cited by 377 publications

References 11 publications

The cardiovascular and central nervous system effects in the human of U-62066E

The cardiovascular and central nervous system effects in the human of U-62066E

Pharmacological and clinical importance of narcotic antagonists and mixed antagonists‐use in cardiology.

Bradycardic Rhythms During Peritoneal Dialysis

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