Abstract
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 ≥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 < 0.05) and decreases in mean blood pressure (78 ± 8 to 70 ± 12 mm Hg, p < 0.05) and mean pulmonary artery pressure (31 ± 4 to 22 ± 5 mm Hg, p < 0.05), without any remarkable change seen in cardiac index (2.21 ± 0.43 to 2.22 ± 0.50 liter/min/m 2, difference not significant), stroke volume index (22 ± 7 to 23 ± 4 ml/m 2, difference not significant), stroke work index (17 ± 7 to 18 ± 7 g · m/m 2), 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 < 0.05) and pH (7.45 ± 0.04 to 7.41 ± 0.03, p < 0.05) and increased arterial PCO 2 (32 ± 6 to 35 ± 6 mm Hg, p < 0.05) without any major change in arterial PO 2 (63 ± 13 to 66 ± 17 mm Hg, difference not significant). All these changes were comparable with morphine sulfate and no statistical difference was noted between the effects induced by both drugs. Nalbuphine's dose ranged from 5 to 30 mg (mean ± standard deviation 17 ± 8 mg) and could not be predicted from baseline hemodynamic and respiratory values.
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