Development of a monitoring protocol for safe use of opioids in children

Abstract

A monitoring protocol incorporating pulse oximetry was developed for children receiving patient-controlled analgesia (PCA) and was applied to 75 children undergoing major abdominal, urological or orthopaedic procedures. Patients used PCA for a mean of of 48.9 h (range 11-147 h). Eighty-three percent of hourly pain scores were 0 or 1, indicating no pain or mild pain, with only 1.7% of 3669 recorded pain scores indicating severe pain. The mean minimum oxyhaemoglobin saturation (Spoz) value while breathing ambient air was 92% (range 8499%). Eightydfour percent of Spo2 recordings were in the range 95-100%. Only 1% of Spoz recordings were <90% and none of these was associated with a slow respiratory rate or oversedation. The mean minimum respiratory rate was 17 (range 10-26). The protocol proved to be easy to use in the general ward. It can be readily adapted for use in all children receiving opioids by whatever route and for children undergoing sedation for investigative procedures.

Epidural and subarachnoid blockade in children

“…To be effective, the measure of sedation should be as objective as possible to avoid bias between observers and with time. The components of the Glasgow Coma Scale which relate to eye opening fulfil these requirements [135].…”

Managing acute pain in children

“…Respiratory rate and depth should be monitored hourly. A respiratory rate of <0/minute (or <0/minute in a child under 5) warrants concern; continuous pulse oximetry may be a more sensitive indicator of respiratory depression 12. If excessive sedation or respiratory depression occurs the infusion should be stopped, a clear airway ensured and oxygen given.…”

“…Patient-controlled analgesia (PCA) - A patient-triggered, computer-controlled, parenteral morphine infusion pump can give good pain control after operations12 , 19 , 20 and has been used successfully in other situations such as sickle-cell crisis 21. PCA may be suitable for children over 5 20.…”

Postoperative Schmerztherapie bei Kindern und Jugendlichen

“…Zu Beginn der PCA muss das Monitoring kontinuierlich, später situationsabhängig alle 2-6 h durchgeführt werden. Zu überwachen sind Sauerstoffsättigung, Atemfrequenz und Sedierungsgrad[16], um Opioidüberdosierungen frühestmöglich zu erkennen (Abb. 1).…”