Opioids and cardioprotection: the impact of morphine and fentanyl on recovery of ventricular function after cardiopulmonary bypass.
OBJECTIVE
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.


METHODS
Prospective, randomized study.


METHODS
University hospital.


METHODS
Forty-six patients undergoing CABG surgery.


METHODS
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.


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.
Murphy
Glenn S
GS
Department of Anesthesiology, Evanston Northwestern Healthcare, Northwestern University Feinberg School of Medicine, Evanston, IL 60201, USA. gmurphy@enh.org
Szokol
Joseph W
JW
Marymont
Jesse H
JH
Avram
Michael J
MJ
Vender
Jeffery S
JS
D000368:Aged; D000701:Analgesics, Opioid / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D002315:Cardiopulmonary Bypass; D002320:Cardiovascular Physiological Phenomena; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D004452:Echocardiography; D005260:Female; D005283:Fentanyl / Q000494:pharmacology*; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D008297:Male; D009020:Morphine / Q000494:pharmacology*; D015428:Myocardial Reperfusion Injury / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000517:prevention & control; D020097:Natriuretic Peptide, Brain / Q000097:blood; D019210:Troponin I / Q000097:blood; D016276:Ventricular Function; D016277:Ventricular Function, Left / Q000187:drug effects*
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D019210:Troponin I; D020097:Natriuretic Peptide, Brain; D009020:Morphine; D005283:Fentanyl