Apnea and Oxygen Desaturations in Children Treated with Opioids after Adenotonsillectomy for Obstructive Sleep Apnea Syndrome

Abstract

Post-operative use of opioids following OSAS may not be safe for all children. It is conceivable that if the child is among the significant proportion that experiences increased oxygen desaturations, the CNS depressing effects of codeine or hydrocodone and their respectively potent morphine or hydromorphone metabolites can further compromise respiratory drive. Larger studies are needed to investigate the potential contribution of CYP2D6 genotype.

A 2013 updated systematic review & meta‐analysis of 36 randomized controlled trials; no apparent effects of non steroidal anti‐inflammatory agents on the risk of bleeding after tonsillectomy

“…Due to genetic variability, some children are rapid metabolisers of CYP 2D6 substrates, including codeine, which may result in life‐threatening CNS depression . Other opiates also depress respiration, which may be potentiated in children who are having tonsillectomies to treat obstructive sleep apnoea, especially if the apnoea does not resolve immediately after surgery …”

Oxycodone Overdose in the Pediatric Population: Case Files of the University of Massachusetts Medical Toxicology Fellowship

“…Although the FDA-boxed warning only applies to codeine use, it is not clear that the use of any opioids is safe in children with OSA postoperatively [40]. Pediatric OSA has an incidence of 2-3.5 %, and up to 33 % of these individuals are not cured of OSA after surgery [40].…”

“…Although the FDA-boxed warning only applies to codeine use, it is not clear that the use of any opioids is safe in children with OSA postoperatively [40]. Pediatric OSA has an incidence of 2-3.5 %, and up to 33 % of these individuals are not cured of OSA after surgery [40]. Additionally, it may take days to weeks for OSA to improve after surgery, and up to 10 % of patients are at risk for perioperative respiratory complications status post tonsillectomy and adenoidectomy [40].…”

A retrospective study of opioid prescribing patterns at hospital discharge in surgical patients with obstructive sleep apnea

“…Opioids have been implicated in postoperative complications in patients both with and without OSA, 21,22,32,33 although no studies have directly evaluated the impact of opioids on post-discharge complications in patients with OSA. Of particular concern is that patients with OSA or STOP-Bang C 5 were prescribed opioids at a similar rate for ambulatory surgeries and at a greater rate and quantity in OSA patients on CPAP.…”