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LETTER TO THE EDITOR

Factors Affecting Morphine Metabolism Following Major Liver Resection

Department of Anaesthesia; Royal Surrey County Hospital; Egerton Road, Guildford; Surrey GU2 7XX, UK; wjfawcett{at}ukonline.co.uk

To the Editor:

Rudin et al.1 demonstrated sedation and impaired morphine metabolism in patients having undergone liver resection. However, the authors did not mention other variables likely to affect liver function and hence morphine metabolism after major liver resection. In particular, it is unclear whether or not ischemic vascular occlusion (Pringle maneuver) was employed and, if so, whether this was related to impaired morphine metabolism. In addition, it would have been interesting to correlate standard tests of liver function (such as prothrombin time, serum bilirubin, or alanine aminotransferase concentrations) with the degree of impaired postoperative morphine metabolism. Postoperative alterations in these variables are known to peak 2 or 3 days after liver resection,2,3 and it would therefore have been useful to have measured morphine metabolism for an additional day or two. This would have been a more scientific assessment of liver function rather than simply asking surgeons to estimate the amount of liver removed.

REFERENCES

1. Rudin A, Lundberg JF, Hammarlund-Udenaes M, Flisberg P, Werner MU. Morphine metabolism after major liver surgery. Anesth Analg 2007;104:1409–14[Abstract/Free Full Text]
2. Patel A, Quiney N, Fawcett W. Perioperative changes in liver function tests following hepatic resection surgery. Eur J Anaesthesiol 2006;23:208 A-807
3. Patel A, Quiney N, Fawcett W. Perioperative coagulation changes following hepatic resection surgery and consequent thoracic epidural risk. Eur J Anaesthesiol 2006;23:88 A-335

This article has been cited by other articles:

				A. Rudin and M. U. Werner Factors Affecting Morphine Metabolism Following Major Liver Resection Anesth. Analg., January 1, 2008; 106(1): 349 - 349. [Full Text] [PDF]

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