Risk Predictors of Opioid-Induced Critical Respiratory Events in Children: Naloxone Use as a Quality Measure of Opioid Safety

Abstract

OIRD is an important, albeit mostly preventable, complication of opioid therapy in children. Naloxone use can be used as a measure to track opioid safety in children, identify contributing factors, and formulate preventive strategies to reduce the risk for OIRD.

Efficacy of premedication with intranasal dexmedetomidine on inhalational induction and postoperative emergence agitation in pediatric undergoing cataract surgery with sevoflurane

“…Previous studies have reported that opioids are suggested to treat emergence agitation; however, opioid-mediated respiratory depression would be a disaster if it were treated improperly [24]. Cho et al [25] demonstrated that intravenous administration of 0.03 mg/kg of midazolam just before the end of surgery can dramatically reduce emergence agitation without delaying the emergence time in children having strabismus surgery with sevoflurane anesthesia.…”

Nurses' Beliefs Regarding Pain in Critically Ill Children: A Mixed-Methods Study

“…The nurses’ lower mean scores for the Total Beliefs items regarding the likelihood of respiratory depression, deep sedation, tolerance, and withdrawal from analgesics administered for acute pain should be interpreted cautiously. While literature supports that opioids administered for severe acute pain in children are safe and effective (Schechter, 2014), withdrawal and tolerance are frequent (Anand et al, 2010), and opioid reversal for respiratory depression is more prevalent (Chidambaran et al, 2014) in children who are critically ill. The nurses’ lower scores for these items likely reflect their experiential knowledge caring for children in PICU.…”

Higher risk of opioid-induced respiratory depression in children with neurodevelopmental disability: a retrospective cohort study of 12 904 patients

“…7,11 Whilst providing some data on the incidence and risks of OIRD in patients with ND, previous studies have been difficult to interpret owing to differences in study design, patient population, opioid drug, route, dosing and dosing frequency, monitoring practices, reporting 15 criteria and the lack of control groups. 3,9,15,16,37,38 A small retrospective cohort study by Long, Ved and Koh found no differences in the risk of 'clinically significant oxygen desaturation' (SpO 2 < 94%) between a group of children with (n=71) and without (n=77) cerebral palsy in the post-anesthesia care unit 9 whereas Chidambaran and others' case-control study, analysing 38 cases of naloxone administration to inpatients in a tertiary children's hospital reported risk factors <1 year, prematurity, OSA, obesity, underweight, and developmental delay. 16 How profound and what type of ND might greater predispose to RD is not known.…”

“…3,9,15,16,37,38 A small retrospective cohort study by Long, Ved and Koh found no differences in the risk of 'clinically significant oxygen desaturation' (SpO 2 < 94%) between a group of children with (n=71) and without (n=77) cerebral palsy in the post-anesthesia care unit 9 whereas Chidambaran and others' case-control study, analysing 38 cases of naloxone administration to inpatients in a tertiary children's hospital reported risk factors <1 year, prematurity, OSA, obesity, underweight, and developmental delay. 16 How profound and what type of ND might greater predispose to RD is not known. In the current study, children with cerebral palsy (non-progressive ND due to perinatal causes), Down's syndrome and encephalopathy appear to be at relatively greatest risk of developing both RD and SAE.…”

“…Communication difficulties, physical and physiological impairments, pharmacokinetic-pharmacodynamic differences and drug interactions add to the complexity of pain management in this group and may contribute to the suggestion that they are more susceptible to OIRD; however few data are available. 3,[6][7][8][9][10][11][12][13][14][15][16] High frequency of pain in children with ND and their increased likelihood to undergo surgery, 7,17 shows a clear need for better understanding of analgesic effects in these vulnerable young people. 7,21 We aimed to quantify the risks of respiratory depression (RD), serious adverse events (SAE), and rates of satisfaction in a group of morphine-treated postoperative children with ND.…”