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Published on: November 6, 2019
Opioid dose and postoperative respiratory adverse events after adenotonsillectomy in medically complex children
Anne Tsampalieros1, Kimmo Murto1,2, Nicholas Barrowman1,3
1Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
Insights
Postoperative respiratory adverse events (PRAEs) after adenotonsillectomy in children are linked to opioid dosage. Careful opioid management is crucial, especially for medically complex children with obstructive sleep-disordered breathing, to reduce PRAE risks.
Area of Science:
- Pediatric Anesthesiology
- Sleep Medicine
- Otolaryngology
Background:
- Obstructive sleep-disordered breathing is a common indication for adenotonsillectomy in children.
- Perioperative opioid dosing in this population requires careful consideration due to potential risks.
Purpose of the Study:
- To describe perioperative opioid dosing in children undergoing adenotonsillectomy for obstructive sleep-disordered breathing.
- To investigate the association between opioid dosing and postoperative respiratory adverse events (PRAEs).
Main Methods:
- Retrospective chart review of 374 children with obstructive sleep-disordered breathing.
- Analysis of preoperative polysomnography and postoperative respiratory adverse events.
- Multivariable logistic regression to identify predictors of PRAEs.
Main Results:
- Opioid dose (morphine equivalents) was a significant predictor of PRAEs.
- Higher apnea-hypopnea index and morphine-equivalent dose were associated with increased PRAE risk.
- Cardiac comorbidity and airway anomalies were also associated with PRAEs.
Conclusions:
- Perioperative opioid dose is a strong predictor of PRAEs in children undergoing adenotonsillectomy.
- Severity of obstructive sleep apnea and opioid dose independently and interactively contribute to PRAEs.
- Mitigating PRAE risk requires attention to opioid dosing, particularly in medically complex children.
Study Objectives:
Obstructive sleep-disordered breathing is commonly treated with adenotonsillectomy. Our study objective was to describe perioperative opioid dosing in children with a range of medical complexity evaluated for obstructive sleep-disordered breathing undergoing adenotonsillectomy and to investigate its association with postoperative respiratory adverse events (PRAEs).
Methods:
A retrospective chart review of children who underwent adenotonsillectomy and had preoperative polysomnography performed was conducted. PRAEs included requiring oxygen, jaw thrust, positive airway pressure, or mechanical ventilation. Multivariable logistic regression was performed to examine for associations between covariates and PRAEs.
Results:
The cohort included 374 children with obstructive sleep-disordered breathing, median (interquartile range) age 6.1 (3.9, 9.3) years; 344 (92%) had obstructive sleep apnea (apnea-hypopnea index > 1 events/h) while 30 (8%) had a normal polysomnogram (apnea-hypopnea index < 1 events/h). The median (interquartile range) postoperative morphine-equivalent dose administered was 0.17 (0.09, 0.25) mg/kg. Sixty-six (17.6%) experienced at least 1 PRAE. Multivariable modeling identified the following predictors of PRAE: younger age at surgery (odds ratio 0.90, 95% confidence interval 0.83, 0.98), presence of cardiac comorbidity (odds ratio 2.07, 95% confidence interval 1.09, 3.89), and presence of airway anomaly (odds ratio 3.48, 95% confidence interval 1.30, 8.94). Higher total apnea-hypopnea index and morphine-equivalent dose were associated with PRAE risk, and an interaction between these variables was detected (P = .01).
Conclusions:
This study identified opioid dose in morphine equivalents to be a strong predictor of PRAE. Additionally, severity of obstructive sleep apnea and postoperative morphine-equivalent dose contributed together and independently to the occurrence of PRAEs. Attention to opioid dosing, particularly among medically complex children with obstructive sleep-disordered breathing, is required to mitigate risk of PRAEs.
Citation:
Tsampalieros A, Murto K, Barrowman N, et al. Opioid dose and postoperative respiratory adverse events after adenotonsillectomy in medically complex children. J Clin Sleep Med. 2022;18(10):2405-2413.
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