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Perioperative opioid requirements are decreased in hypoxic children living at altitude

Jennifer A Rabbitts1, Cornelius B Groenewald, Niki M Dietz

  • 1Department of Anesthesiology, Mayo Foundation for Education and Research, Rochester, MN 55905, USA. rabbitts.jennifer@mayo.edu

Paediatric Anaesthesia
|January 5, 2011
PubMed

Insights

Children at high altitude required 40% less opioid medication for pain management during surgery. This study suggests altitude-induced hypoxia may reduce perioperative opioid needs in pediatric patients.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Altitude Medicine

Background:

  • Studies suggest hypoxia enhances opioid analgesic effects in animals and children with sleep apnea.
  • Perioperative opioid requirements in otherwise healthy children at high altitude remain understudied.

Purpose of the Study:

  • To investigate the impact of altitude on perioperative opioid requirements in healthy pediatric surgical patients.
  • To compare fentanyl doses administered to children undergoing surgery at high altitude versus sea level.

Main Methods:

  • Retrospective review of opioid requirements in pediatric patients undergoing cleft lip/palate surgery in Peru (2007-2009).
  • Comparison of patients operated at high altitude (Cusco, 3399 masl) versus sea level (Lima, 150 masl).
  • Standardized anesthesia with intravenous fentanyl as the sole perioperative opioid.

Main Results:

  • 102 patients at high altitude (Cusco) and 169 at sea level (Lima).
  • High-altitude patients had lower baseline oxygen saturation (92% vs 98%, P < 0.001).
  • High-altitude patients received 40% less opioid (1.2 vs 2.0 μg·kg⁻¹·h⁻¹, P < 0.001).

Conclusions:

  • Opioid administration was significantly reduced in healthy children experiencing altitude-induced chronic hypoxia.
  • The observed reduction in opioid requirements may be attributed to altitude or altitude-induced hypoxia.
  • Further research is needed to elucidate the precise relationship between altitude, hypoxia, and opioid efficacy.
Abstract

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