Original articleMorphine pharmacokinetics in children following cardiac surgery: Effects of disease and inotropic support
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2014, Advanced Drug Delivery ReviewsCitation Excerpt :These doses, particularly the bolus dose, were greater than doses proposed for neonates not on ECMO, reflecting circuit sequestration. In two other studies, higher dosage regimens of morphine were necessary to obtain the same level of analgesia in ECMO neonatal patients [108,109]. The Vd of several drugs is increased during ECMO therapy for several reasons: priming fluid used to fill the ECMO circuits, drug sequestration, fluid resuscitation, changes in protein-binding due to secondary hypoalbuminemia, altered pH, systemic inflammatory response with capillary leakage secondary to the extracorporeal circuit and the up-regulation of the renin–angiotensin system, resulting in fluid retention, due to the non-pulsatile character of the pump, especially when VA-ECMO is used [110–115].
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