Effects of extracorporeal membrane oxygenation on morphine pharmacokinetics in infants

ObjectivesTo study the effect of extracorporeal membrane oxygenation (ECMO) on the pharmacokinetics of morphine in infants. DesignA prospective, comparative study of morphine pharmacokinetics during and after ECMO. SettingThe pediatric intensive care unit at a children's hospital. PatientsSeven infants, aged 1 day to 12 months, requiring ECMO. InterventionInfusion of morphine. Measurement and Main ResultsSteady-state concentrations of morphine were used to generate a morphine clearance rate. Plasma clearance rate of morphine increased from 0.574 ± 0.3 L/kg/hr to 1.058 ± 0.727 L/kg/hr after discontinuation of ECMO (p < .01). Two infants experienced a clinical picture consistent with opioid withdrawal. ConclusionInfants requiring morphine after ECMO may require higher dose rates to maintain adequate sedation. (Crit Care Med 1994; 22:1099–1101)