ECMO-/ECLS

 Onset & elimination: slow elimination, long duration of action; half

life 19 hours

 Metabolism: hepatic metabolism. metabolite is morphine

 Precautions:

o prolonged QT syndrome, torsades de pointes

o Respiratory depressant effects occur after analgesic

effects

4. Codeine [13]
    Clinical effects: inactive until metabolized in liver by cytochrome
   P450 2D6 into morphine. It has unpredictable effects in patients
   with liver failure.
    Dosing 0.5-1mg/kg q3-4 hours
    Current FDA warning in children after tonsillectomy and
   adenoidectomy. Children with ultra-rapid metabolism for this drug
   can have higher than normal doses of converted morphine in their
   system
    10% of children are poor metabolizers and will experience less
   analgesia


5. Hydromorphone [6]
    No active metabolites. Five times more potent than morphine.
    Dosing 0.01-0.03mg/kg q2 hours