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Published on: September 24, 2020

Opioid-induced respiratory depression in paediatrics: a review of case reports

M Niesters1, F Overdyk, T Smith

  • 1Department of Anesthesiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.

British Journal of Anaesthesia
|December 19, 2012
PubMed

Insights

Opioid-induced respiratory depression (OIRD) in children is life-threatening. Key risk factors include renal impairment, genetic variations affecting codeine metabolism, and post-adenotonsillectomy use, highlighting specific pediatric OIRD patterns.

Area of Science:

  • Pediatric Anesthesiology
  • Clinical Pharmacology
  • Pharmacogenetics

Background:

  • Opioids are essential for pediatric pain management but carry risks.
  • Opioid-induced respiratory depression (OIRD) incidence in children is unknown.
  • Understanding OIRD patterns is crucial for pediatric patient safety.

Purpose of the Study:

  • To identify specific patterns and risk factors for OIRD in pediatric patients.
  • To analyze case reports of OIRD in children aged 12 years or younger.
  • To investigate OIRD development in both medically treated and perinatal exposure cases.

Main Methods:

  • Systematic search of PubMed for OIRD case reports up to May 2012.
  • Inclusion of pediatric patients (≤12 years) requiring naloxone, intubation, or resuscitation.
  • Analysis of 27 cases from 24 reports to identify distinct OIRD development patterns.

Main Results:

  • Seven of the 27 cases were fatal.
  • Eight cases resulted from iatrogenic overdose.
  • Identified patterns: morphine accumulation in renal impairment, enhanced morphine from codeine in CYP2D6 ultra-rapid metabolizers, and OIRD post-adenotonsillectomy potentially linked to hypoxia.

Conclusions:

  • Specific risk factors contribute to OIRD in pediatric populations.
  • Renal impairment, CYP2D6 gene polymorphism, and post-adenotonsillectomy status are critical considerations.
  • Further research is needed to refine management strategies and improve safety.

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