morphinans and Myocardial-Infarction

The hemodynamic and respiratory effects of intravenous nalbuphine hydrochloride and morphine sulfate were compared in a randomized fashion in 20 patients (age 65 +/- 11 years) with acute myocardial infarction and elevated pulmonary artery wedge pressure. Titration of the nalbuphine dose to lower pulmonary artery wedge pressure by greater than or equal to 25% resulted in a decrease of this parameter from 22 +/- 3 to 15 +/- 4 mm Hg, and was associated with a reduction in heart rate from 106 +/- 20 to 96 +/- 19 beats/min (p less than 0.05) and decreases in mean blood pressure (78 +/- 8 to 70 +/- 12 mm Hg, p less than 0.05) and mean pulmonary artery pressure (31 +/- 4 to 22 +/- 5 mm Hg, p less than 0.05), without any remarkable change seen in cardiac index (2.21 +/- 0.43 to 2.22 +/- 0.50 liter/min/m2, difference not significant), stroke volume index (22 +/- 7 to 23 +/- 4 ml/m2, difference not significant), stroke work index (17 +/- 7 to 18 +/- 7 g.m/m2), or systemic and pulmonary vascular resistances (1,675 +/- 333 to 1,513 +/- 508 and 191 +/- 78 to 170 +/- 109 dynes.s.cm-5 respectively, all differences not significant). Nalbuphine also significantly reduced respiratory rate (32 +/- 8 to 26 +/- 8 resp/min, p less than 0.05) and pH (7.45 +/- 0.04 to 7.41 +/- 0.03, p less than 0.05) and increased arterial PCO2 (32 +/- 6 to 35 +/- 6 mm Hg, p less than 0.05) without any major change in arterial PO2 (63 +/- 13 to 66 +/- 17 mm Hg, difference not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Female; Hemodynamics; Humans; Infusions, Intravenous; Male; Middle Aged; Morphinans; Morphine; Myocardial Infarction; Nalbuphine; Prospective Studies; Pulmonary Wedge Pressure; Random Allocation; Respiration

A total of 141 patients admitted to hospital with a diagnosis of suspected myocardial infarction were randomized to treatment with intravenous diamorphine (71) or nalbuphine (70). Myocardial infarction was subsequently confirmed in 109 patients. Both drugs provided good analgesia. Heart rate, blood pressure, respiratory rate, peak flow and minute volume were measured over a three-hour study period. Except for a slight fall in systolic blood pressure in the nalbuphine-treated group, there were no statistically significant differences between the groups. The nalbuphine-treated group had higher levels of aspartate aminotransferase and hydroxybutyric acid dehydrogenase but not creatine phosphokinase. The haemodynamic outcome and mortality at three months of the two groups were similar. It is concluded that nalbuphine provides effective analgesia coupled with few adverse circulatory or respiratory effects.

Topics: Analgesics; Clinical Trials as Topic; Double-Blind Method; Female; Hemodynamics; Heroin; Humans; Male; Middle Aged; Morphinans; Myocardial Infarction; Nalbuphine; Prospective Studies; Random Allocation; Respiration

One hundred and seventy-six consecutive patients with moderate or severe pain of suspected myocardial infarction were randomized to receive nalbuphine less than or equal to 20 mg or diamorphine less than or equal to 5 mg intravenously with metoclopramide 10 mg and were observed over 2 hours. One hundred and forty-two patients (81%) received the test drug outside hospital. The median time from symptom onset to treatment was 135 minutes for the nalbuphine group and 125 minutes for the diamorphine group. Satisfactory pain relief (grade 0 or 1) was similar for both groups at each time assessment. In particular, within 10 minutes of the drug's administration 77% of those receiving nalbuphine and 68% who received diamorphine had satisfactory pain relief. The number of doses of each drug, the number of patients withdrawn from the trial because of unsatisfactory pain relief or recurrence of chest pain were similar for both groups. For those with myocardial infarction there was similar satisfactory pain relief with nalbuphine as diamorphine. No significant deleterious haemodynamic effects or other side-effects occurred. The noncontrolled classification and low addiction potential of nalbuphine allow for its more widespread use in the control of pain of suspected myocardial infarction.

Topics: Adult; Aged; Drug Evaluation; Female; Heroin; Humans; Injections, Intravenous; Male; Middle Aged; Morphinans; Myocardial Infarction; Nalbuphine; Random Allocation

Hemodynamic effects of morphine and the new narcotic analgesic, nalbuphine, were compared in a randomized, double-blind study in 15 patients with acute myocardial infarction (11 men and four women, average age 56.2 yr) and normal group mean hemodynamic function. During a 1-hr evaluation the hemodynamic effects were small but there were changes in several parameters. Morphine reduced heart rate (78 to 72 bpm, p less than 0.01) and diastolic and mean arterial pressures (69 to 64 mm Hg, p less than 0.05; and 91 to 84 mm Hg, p less than 0.05); nalbuphine was associated with a decrease in heart rate (82 to 72 bpm, p less than 0.01), decrease in cardiac index, which remained within the normal range (3.16 to 2.75 l/min/m(2), p less than 0.01), and an increase in systemic vascular resistance (1,204 to 1,461 dynes . sec . cm(-5), p less than 0.05). Neither drug altered systolic arterial pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, stroke index, stroke work index, or pulmonary vascular resistance. Echocardiographic assessment revealed diminution of left ventricular mean velocity of circumferential fiber shortening after nalbuphine (1.26 to 1.08 circ/sec, p less than 0.05). Both drugs induced small reductions in respiratory rate and arterial pH and increases in PAO2. There were no changes in PaO2. Because of the absence of clinically important deleterious effects on cardiac pump function, nalbuphine merits further investigation as an analgesic in acute myocardial infarction.

Topics: Adult; Aged; Blood Gas Analysis; Double-Blind Method; Echocardiography; Female; Hemodynamics; Humans; Male; Middle Aged; Morphinans; Morphine; Myocardial Infarction; Nalbuphine; Random Allocation; Respiration

Buprenorphine, a new powerful analgesic agent, was used to treat chest pain in patients with suspected myocardial infarction. Initial studies showed no significant changes in systemic or pulmonary artery blood pressure or in heart rate after intravenous buprenorphine. Sublingual buprenorphine also appeared effective in relieving pain, but its onset of action was considerably delayed compared with the intravenous route. A randomised double-blind controlled trial of equivalent doses of buprenorphine and diamorphine showed no significant difference between the drugs in terms of pain relief and duration of action. The occurrence of nausea, vomiting, and other side effects was similar in the two groups. The onset of action of buprenorphine was slightly but significantly slower than that of diamorphine. Since buprenorphine seems to be comparable with diamorphine in action and is not a controlled drug, it may prove useful in both general and hospital practice.

Topics: Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Female; Hemodynamics; Heroin; Humans; Male; Middle Aged; Morphinans; Myocardial Infarction; Random Allocation

The intravenous infusion of naloxone (Nal) (0.17 mg/kg/min) and of the selective kappa antagonist MR 1452 MS (0.07 mg/kg/min) on rats with left coronary artery occlusion was studied. The results demonstrated significant improvement of cardio-circulatory parameters, i.e., mean arterial pressure (MAP), heart rate (HR) and cardiac output (CO). The action of Nal is peripheral and central with prevalence of central effect, since its hypertensive effect is due to a rise in total peripheral resistance (TPR) (by 12%), rather than to an increase of CO (by 3% compared to saline-treated rats 20 min postinfarction). The effect of MR 1452 MS is mainly peripheral, since MAP increased due to increased CO (by 5% and by 8% compared to saline-treated animals 20 min and 2 h postinfarction). As a result of increased MAP and CO a reduction of myocardial oxygen deficiency was evident, and the development of cardiogenic shock in Nal- and MR 1452 MS-treated animals decreased by 7% and by 17% 2 and 24 h postinfarction. Reduction of the incidence of early arrhythmias (20 min-2 h postinfarction) by 25% and 16%, respectively, was found. Mortality was significantly reduced in both groups by 8% 2 h postinfarction and by 17% 24 h postinfarction, which suggested a comparable effect of both drugs in cardiogenic shock.

Topics: Acid-Base Equilibrium; Animals; Benzomorphans; Blood Pressure; Electrocardiography; Heart Rate; L-Lactate Dehydrogenase; Male; Morphinans; Myocardial Infarction; Naloxone; Narcotic Antagonists; Rats; Rats, Inbred Strains; Respiration

Twenty patients with moderate or severe pain of suspected myocardial infarction received nalbuphine 50 mg intravenously as analgesia in 2 divided doses of 30 mg and 20 mg with 10 mg metoclopramide and were observed for 2 hours. Eighteen patients received nalbuphine outside hospital. The median time from onset of pain to treatment was 73 minutes. Within 30 minutes of the drug's administration 90% of all patients reported satisfactory pain relief (grade 0 or 1). For those with definite myocardial infarction 83% reported satisfactory pain relief at 30 minutes. There were no significant adverse cardiorespiratory effects observed or serious side-effects reported. Nalbuphine is effective and safe when used in this higher dose, although no additional analgesic effect was demonstrated when compared with lower established doses used early in acute myocardial infarction.

Topics: Chest Pain; Humans; Injections, Intravenous; Morphinans; Myocardial Infarction; Nalbuphine

Topics: Animals; Arrhythmias, Cardiac; Buprenorphine; Coronary Vessels; Dogs; Dose-Response Relationship, Drug; Female; Ligation; Male; Morphinans; Myocardial Infarction; Naloxone

Topics: Buprenorphine; Cost-Benefit Analysis; Heroin; Humans; Morphinans; Myocardial Infarction

Topics: Buprenorphine; Heroin; Humans; Morphinans; Myocardial Infarction; Respiratory Insufficiency

Topics: Adult; Aged; Anticoagulants; Arrhythmias, Cardiac; Atropine; Coronary Care Units; Coronary Disease; Diazepam; Digitalis Glycosides; Electrocardiography; Female; Humans; Intensive Care Units; Lidocaine; Male; Middle Aged; Morphinans; Myocardial Infarction; Pentazocine; Propranolol

Topics: Anticoagulants; Humans; Morphinans; Myocardial Infarction