Higher risk of opioid-induced respiratory depression in children with neurodevelopmental disability: a retrospective cohort study of 12 904 patients

Jay, Matthew A; Thomas, Betsy; Nandi, Reema; Howard, Richard

doi:10.1093/bja/aew403

Cited by 29 publications

(28 citation statements)

References 31 publications

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“…[14]. Tatsächlich war das Risiko einer Atemdepression nach postoperativen Morphingaben bei entwicklungsverzögerten Kindern in einer aktuellen großen retrospektiven Studie 1,8-fach erhöht [15]. Dieses Risiko ist aber immer noch extrem niedrig und sicher kein Grund, den Kindern unter entsprechender Überwachung eine suffiziente Schmerztherapie vorzuenthalten.…”

Section: Merkeunclassified

Anästhesie bei Kindern und Jugendlichen mit Behinderung

Laschat¹,

Kaufmann²,

Wappler³

2020

Anästhesiol Intensivmed Notfallmed Schmerzther

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ZusammenfassungDie sichere anästhesiologische Versorgung von Kindern und Jugendlichen mit körperlichen oder geistigen Behinderungen ist zumeist zeitaufwendig und anspruchsvoll. In diesem Beitrag wollen wir auf Besonderheiten in der perioperativen Versorgung von behinderten Kindern und Jugendlichen hinweisen. Auf die Probleme bei der Anästhesie von Kindern mit Autismus-Spektrum-Störung, infantiler Zerebralparese und Trisomie 21 gehen wir im Anschluss näher ein.

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Section: Merkeunclassified

Anästhesie bei Kindern und Jugendlichen mit Behinderung

Laschat¹,

Kaufmann²,

Wappler³

2020

Anästhesiol Intensivmed Notfallmed Schmerzther

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“…Table 2 shows detailed information on the six included articles. Four of these articles reported on retrospective data [26][27][28][29], while two articles reported on prospective data [30,31]. Four studies were conducted in the United States of America [26,28,29,31], one in the United Kingdom [27], and one in the United Kingdom and the Republic of Ireland [30].…”

Section: Selection Of Sources Of Evidencementioning

confidence: 99%

Opioid-Induced Respiratory Depression in Pediatric Palliative Care Patients with Severe Neurological Impairment—A Scoping Literature Review and Case Reports

Mauritz

Hasan

Dreier³

et al. 2020

Children

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Pediatric Palliative Care (PPC) addresses children, adolescents, and young adults with a broad spectrum of underlying diseases. A substantial proportion of these patients have irreversible conditions accompanied by Severe Neurological Impairment (SNI). For the treatment of pain and dyspnea, strong opioids are widely used in PPC. Nonetheless, there is considerable uncertainty regarding the opioid-related side effects in pediatric patients with SNI, particularly concerning Opioid-Induced Respiratory Depression (OIRD). Research on pain and OIRD in pediatric patients with SNI is limited. Using scoping review methodology, we performed a systematic literature search for OIRD in pediatric patients with SNI. Out of n = 521 identified articles, n = 6 studies were included in the review. Most studies examined the effects of short-term intravenous opioid therapy. The incidence of OIRD varied between 0.13% and 4.6%; besides SNI, comorbidities, and polypharmacy were the most relevant risk factors. Additionally, three clinical cases of OIRD in PPC patients receiving oral or transdermal opioids are presented and discussed. The case reports indicate that the risk factors identified in the scoping review also apply to adolescents and young adults with SNI receiving low-dose oral or transdermal opioid therapy. However, the risk of OIRD should never be a barrier to adequate symptom relief. We recommend careful consideration and systematic observation of opioid therapy in this population of patients.

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“…Therefore, other measures to improve patient monitoring must be considered including an increased surveillance of the patient and preoperative identification of risk factors for respiratory depression such as presence of respiratory problems, neurologic disease, renal disease, obesity, etc. ( 12 , 16 , 33 ).…”

Section: The Silent Dangers Of Pca Use In Children and Adolescentsmentioning

confidence: 99%

Safety of Patient-Controlled Analgesia After Surgery in Children And Adolescents: Concerns And Potential Solutions

et al. 2018

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Patient-controlled analgesia (PCA) is common practice for acute postoperative pain management. Postoperative PCA use decreases pain intensity and improves patient satisfaction when compared to non-PCA routes of medication administration. Although PCA has several advantages regarding efficacy and safety, adverse events remain a concern. Programming errors and protocols, patient monitoring, and PCA by proxy or with continuous infusion are recurring silent dangers of PCA use in children and adolescents. Innovative considerations need to be emphasized for future improvement of PCA devices for elective surgical patients. With technology within the healthcare setting advancing at a fast pace, smart pump technology is something to look forward to.

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Higher risk of opioid-induced respiratory depression in children with neurodevelopmental disability: a retrospective cohort study of 12 904 patients

Abstract: Background

Cited by 29 publications

References 31 publications

Anästhesie bei Kindern und Jugendlichen mit Behinderung

Anästhesie bei Kindern und Jugendlichen mit Behinderung

Opioid-Induced Respiratory Depression in Pediatric Palliative Care Patients with Severe Neurological Impairment—A Scoping Literature Review and Case Reports

Safety of Patient-Controlled Analgesia After Surgery in Children And Adolescents: Concerns And Potential Solutions

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