More codeine fatalities after tonsillectomy in North American children. Time to revise prescribing practice!

Robb, Peter

doi:10.1111/coa.12174

Cited by 8 publications

(8 citation statements)

References 9 publications

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“…Again, caution should be taken using ibuprofen in the presence of dehydration, and diclofenac is not recommended in children due to insufficient evidence to establish its safety . Recent medicines and healthcare products regulatory agency guidance has suggested caution over the use of codeine within the paediatric population, especially in those with potential respiratory depression (level 4 evidence) …”

Section: Resultsmentioning

confidence: 99%

Controversies in the management of acute tonsillitis: an evidence‐based review

Bird

Biggs

King

2014

Clinical Otolaryngology

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Management of acute tonsillitis within a secondary care setting largely consists of anecdotal or relatively low-quality evidence. Thus, much evidence from management comes from expert opinion or practice within a primary care setting. Management across the UK can also vary greatly. An evidence-based review of best practice has been presented here, but further evidence will be required in the future examining the significance of corticosteroids and antibiotic administration in this patient cohort specifically, ensuring practice is evidence based and clinically relevant.

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Section: Resultsmentioning

confidence: 99%

Controversies in the management of acute tonsillitis: an evidence‐based review

Bird

Biggs

King

2014

Clinical Otolaryngology

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“…In synthesizing this information with the notion that opioid requirement is lower in children with SDB, there have been a frightening number of deaths associated with codeine after adenotonsillectomy. 3,5,47 In April 2017, the Food and Drug Administration (FDA) placed a restriction on the use of codeine and tramadol (also a CYP 2D6 substrate) medication in children, elevating their previous "warning" that was added in 2013. This is their strongest warning, and bottles of these medications now say "Contraindication" for children and "Warning" for adolescents.…”

Section: Anesthesia Considerationsmentioning

confidence: 99%

“…This increased sensitivity can prolong recovery time and increase the risk for respiratory complications. A number of studies have highlighted this risk and sought to identify non‐opioid alternatives with non‐inferior pain control . Factors identified on PSG such as oxygen nadir, apnea‐hypopnea index (AHI), and other clinical parameters have been studied and should be utilized to help establish more concrete guidelines for postoperative monitoring and care.…”

Section: Introductionmentioning

confidence: 99%

“…A number of studies have highlighted this risk and sought to identify non-opioid alternatives with non-inferior pain control. [2][3][4][5][6][7][8] The inability for the OSA-18 to predict OSA or its severity in children has been reported by smaller studies as well. [13][14][15][16] A recent study by Raman et al 17 created a shortened scale version of the PSQ-SRBD consisting of 6 questions based on multivariable analysis to predict OSA.…”

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confidence: 97%

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Diagnosis and perioperative management in pediatric sleep‐disordered breathing

Scalzitti

Sarber

2018

Pediatric Anesthesia

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Summary Sleep‐disordered breathing has a prevalence of 12% in the pediatric population. It represents a spectrum of disorders encompassing abnormalities of the upper airway that lead to sleep disruption, including primary snoring, obstructive sleep apnea, central sleep apnea, and sleep‐related hypoventilation. Sleep‐disordered breathing is the most common indication for adenotonsillectomy, one of the most common procedures performed in children. In recent years, the American Academy of Otolaryngology‐Head and Neck Surgery, American Academy of Pediatrics, and the American Society of Anesthesiologists have crafted guidelines to help safely manage children with sleep‐disordered breathing. Each organization recommends in‐laboratory polysomnography for definitive diagnosis of obstructive sleep apnea in certain cases. However, because this test is both costly and inconvenient, there has been significant interest in alternative methods for diagnosing clinically significant sleep‐disordered breathing. Accurate diagnosis is critical because sleep‐disordered breathing confers certain perioperative risks and increased mortality in some instances. Recent studies have elucidated the danger of anesthesia and opioids in worsening obstructive sleep apnea, and recommendations for alternative analgesia are being created. In addition, determining the most appropriate level and duration of monitoring in the postoperative period is actively being evaluated. This article presents an overview of the recent literature on the perioperative care of pediatric patients with sleep‐disordered breathing. It highlights innovative modalities and limitations in diagnosing obstructive sleep apnea, the importance of a tailored anesthetic/analgesic approach to children with obstructive sleep apnea, and the need for postoperative monitoring. It also brings to focus that further studies on the perioperative care of these children are necessary.

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“…Postoperative respiratory depression and arrest have been reported with standard (0.5 to 1 mg/kg) doses of codeine in posttonsillectomy patients. 31,32 Codeine is being removed from pediatric hospital formularies and its use discouraged in the postoperative tonsillectomy patient for this reason.…”

Section: Bilateral Myringotomy and Pressure Equalization Tube Placementmentioning

confidence: 99%

Acute Postoperative Pain Management in Infants and Children

Birmingham¹

2015

ASA Refresher Courses in Anesthesiology

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More codeine fatalities after tonsillectomy in North American children. Time to revise prescribing practice!

Cited by 8 publications

References 9 publications

Controversies in the management of acute tonsillitis: an evidence‐based review

Controversies in the management of acute tonsillitis: an evidence‐based review

Diagnosis and perioperative management in pediatric sleep‐disordered breathing

Acute Postoperative Pain Management in Infants and Children

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