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Cardiovascular Response to Large Doses of Intravenous Morphine in Man

1969; Massachusetts Medical Society; Volume: 281; Issue: 25 Linguagem: Inglês

10.1056/nejm196912182812503

1533-4406

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

Anesthesia and Pain Management

Large doses of intravenous morphine (0.5 to 3.0 mg per kilogram of body weight) were used alone or in combination with inhalation anesthetic agents for anesthesia in over 1100 patients undergoing open-heart surgery. Morphine, 1 mg per kilogram, was administered intravenously to seven subjects with aortic-valve disease and eight without major heart or lung disease. The cardiac subjects had higher control pulse rates and lower control stroke indexes than the normal subjects. In the cardiac but not in the normal subjects, significant increases in cardiac index, stroke index, central venous pressure, and pulmonary-artery pressure, and a significant decrease in systemic vascular resistance, were observed after morphine was administered, suggesting that large doses of morphine may be used with safety in patients with minimal circulatory reserve.