Rosow C E, Moss J, Philbin D M, Savarese J J
Anesthesiology. 1982 Feb;56(2):93-6. doi: 10.1097/00000542-198202000-00003.
High doses of morphine produced peripheral vasodilation and frequently significant hypotension. These effects are thought to be due, in part, to the release of histamine. One putative advantage of high-dose fentanyl anesthesia is its relatively small effect on peripheral vascular resistance. In a randomized study, the authors examined the possibility that the hemodynamic differences between morphine and fentanyl might be attributable to histamine release. Fifteen patients were studied prior to coronary artery bypass surgery. Subjects received in infusion of morphine (1 mg . kg-1, iv at 100 micrograms . kg-1 . min-1 [n = 8]) or fentanyl (50 micrograms . kg-1 at 5 micrograms . kg-1 . min-1 [n = 7]). Patients in the morphine group had an average 750 per cent peak increase in plasma histamine accompanied by a significant decrease in mean arterial pressure (-27 mmHg- and systemic vascular resistance (-520 dyne . s . cm-5). The greatest decrease in systemic vascular resistance occurred in those patients with the highest levels of plasma histamine (r = -0.81). Patients in the fentanyl group had no change in plasma histamine and no decrease in arterial pressure or systemic vascular resistance. Cardiac output and heart rate were comparable between the two groups. Differences in the release of histamine account for most, if not all, of the different effects of morphine and fentanyl on the peripheral vasculature.
大剂量吗啡可导致外周血管扩张，并常常引起显著的低血压。这些效应被认为部分归因于组胺的释放。大剂量芬太尼麻醉的一个假定优势是其对外周血管阻力的影响相对较小。在一项随机研究中，作者探讨了吗啡和芬太尼之间血流动力学差异可能归因于组胺释放的可能性。对15例冠状动脉搭桥手术患者进行了研究。受试者接受吗啡输注（1mg·kg-1，静脉注射，速度为100μg·kg-1·min-1[n = 8]）或芬太尼输注（50μg·kg-1，速度为5μg·kg-1·min-1[n = 7]）。吗啡组患者血浆组胺峰值平均增加750%，同时平均动脉压显著下降（-27mmHg）和全身血管阻力显著下降（-520达因·秒·厘米-5）。全身血管阻力下降最大的患者血浆组胺水平最高（r = -0.81）。芬太尼组患者血浆组胺无变化，动脉压或全身血管阻力也无下降。两组的心输出量和心率相当。组胺释放的差异解释了吗啡和芬太尼对外周血管系统不同作用的大部分（如果不是全部）原因。
