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Opioid Sensitivity in Children with and without Obstructive Sleep Apnea

Michael C Montana1, Lindsay Juriga, Anshuman Sharma

  • 1From the Department of Anesthesiology, Washington University in St. Louis, School of Medicine, St. Louis, Missouri (M.C.M., L.J., A.S., E.D.K.) the Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina (E.D.K.).

Anesthesiology
|March 15, 2019
PubMed

Insights

Children with obstructive sleep apnea do not show increased sensitivity to remifentanil, a common opioid. This study found no significant differences in miotic or respiratory effects between children with and without obstructive sleep apnea when given remifentanil.

Area of Science:

  • Anesthesiology
  • Pediatric Pharmacology
  • Sleep Medicine

Background:

  • Opioids are frequently used for pain relief during surgery.
  • Concerns exist regarding increased opioid sensitivity and respiratory risks in children with obstructive sleep apnea (OSA).
  • Previous assumptions about heightened opioid effects in pediatric OSA patients lack rigorous testing.

Purpose of the Study:

  • To investigate if children with obstructive sleep apnea exhibit increased pharmacodynamic sensitivity to remifentanil.
  • To compare the miotic and respiratory depressant effects of remifentanil in children with and without OSA.

Main Methods:

  • Administered fixed-rate remifentanil infusions to children aged 8-14 years with or without OSA.
  • Measured plasma remifentanil concentrations using liquid chromatography-mass spectrometry.
  • Assessed remifentanil effects by monitoring miosis, respiratory rate, and end-expired carbon dioxide.

Main Results:

  • Remifentanil induced miosis in both groups without significant differences in the concentration-effect relationship.
  • No significant alterations in respiratory rate or end-expired carbon dioxide were observed in either group.
  • The tested doses of remifentanil did not differentially affect ventilatory parameters based on OSA status.

Conclusions:

  • Children with obstructive sleep apnea do not display increased sensitivity to the miotic effects of remifentanil.
  • Remifentanil administration did not impact respiratory parameters differently in children with or without OSA.
  • The findings challenge prior assumptions regarding heightened opioid sensitivity in pediatric OSA.
Abstract

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