An assessment of opioids on respiratory depression in children with and without obstructive sleep apnea

Adam C. Adler, Arvind Chandrakantan, Brian H. Nathanson, Britta S. von Ungern-Sternberg

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Obstructive sleep apnea is a risk factor for respiratory depression following opioid administration as well as opioid-induced hyperalgesia. Little is known on how obstructive sleep apnea status is associated with central ventilatory depression in pediatric surgical patients given a single dose of fentanyl. Methods: This was a single-center, prospective trial in children undergoing surgery requiring intubation and opioid administration. Sixty patients between the ages of 2–8 years presenting for surgery at Texas Children's Hospital were recruited. Twenty non-obstructive sleep apnea controls and 30 patients with moderate to severe obstructive sleep apnea met inclusion criteria. Following induction of general anesthesia and establishment of steady-state ventilation, participants received 1 mcg/kg intravenous fentanyl. Ventilatory variables (tidal volume, respiratory rate, end-tidal CO2, and minute ventilation) were assessed each minute for 10 min. The primary outcome was the extent of opioid-induced central ventilatory depression over time by obstructive sleep apnea status when compared with baseline values. Secondary aims assessed the impact of demographics and SpO2 nadir on ventilatory depression. Results: We found no significant difference in percent decrease in respiratory rate (38.1% and 37.1%; p =.950), tidal volume (6.4% and 5.4%; p =.992), and minute ventilation (35.0 L/min and 35.0 L/min; p =.890) in control and obstructive sleep apnea patients, respectively. Both groups experienced similar percent increases in end-tidal CO2 (4.0% vs. 2.2%; p =.512) in control and obstructive sleep apnea patients, respectively. Conclusions: In pediatric surgical patients, obstructive sleep apnea status was not associated with significant differences in central respiratory depression following a single dose of fentanyl (1 mcg/kg). These findings can help determine safe opioid doses in future pediatric obstructive sleep apneapatients.

Original languageEnglish
Pages (from-to)977-984
Number of pages8
JournalPaediatric Anaesthesia
Volume31
Issue number9
DOIs
Publication statusPublished - Sep 2021

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