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Pharmacokinetics and ventilatory effects of intravenous oxycodone in postoperative children
K T Olkkola1, K Hamunen, T Seppälä
1Department of Anaesthesia, University of Helsinki, Finland.
Insights
Oxycodone hydrochloride, an opioid analgesic, caused significant respiratory depression in children following ophthalmic surgery. This effect was more pronounced than with other opioid analgesics at comparable doses.
Area of Science:
- Anesthesiology
- Pediatric Pharmacology
- Pharmacokinetics
Background:
- Opioid analgesics are commonly used for postoperative pain management in children.
- Understanding the pharmacokinetic and pharmacodynamic properties of specific opioids is crucial for safe pediatric use.
- Oxycodone is a potent opioid with potential for respiratory depression.
Purpose of the Study:
- To evaluate the pharmacokinetics and respiratory effects of intravenous oxycodone hydrochloride in pediatric patients undergoing ophthalmic surgery.
- To assess the impact of oxycodone on ventilatory parameters and oxygen saturation in this population.
Main Methods:
- A prospective study involving 18 children who received intravenous oxycodone hydrochloride (0.1 mg kg-1) post-ophthalmic surgery.
- Serial plasma sampling for pharmacokinetic analysis (clearance, volume of distribution).
- Continuous monitoring of blood pressure, heart rate, oxygen saturation, end-tidal carbon dioxide, and ventilatory rate.
Main Results:
- Mean clearance of oxycodone was 15.2 mL/min/kg and volume of distribution was 2.1 L/kg.
- Peak end-tidal carbon dioxide and nadir ventilatory rate occurred at 8 minutes post-administration.
- Minimum peripheral oxygen saturation was observed at 4 minutes post-administration.
Conclusions:
- Intravenous oxycodone hydrochloride at 0.1 mg kg-1 resulted in significant, dose-dependent respiratory depression in children after ophthalmic surgery.
- The observed ventilatory depression may be greater compared to other opioids at equivalent analgesic doses.
- This study highlights the importance of careful monitoring of respiratory function in pediatric patients receiving oxycodone.
Abstract:
1. Oxycodone hydrochloride (0.1 mg kg-1) was given by intravenous bolus to 18 children after ophthalmic surgery. Plasma was sampled for up to 8 h. Blood pressure, heart rate, peripheral arteriolar oxygen saturation, end-tidal carbon dioxide and halothane concentrations and ventilatory rate were also recorded. 2. Mean (+/- s.d.) values of drug clearance and volume of distribution (Vss) were 15.2 +/- 4.2 ml min-1 kg-1 and 2.1 +/- 0.8 l kg-1. Maximum mean end-tidal carbon dioxide concentration and minimum mean ventilatory rate occurred 8 min after administration of oxycodone but the minimum mean peripheral arteriolar oxygen saturation occurred at 4 min. 3. Oxycodone (0.1 mg kg-1) appears to cause greater ventilatory depression than comparable analgesic doses of other opioids.