Donempudi Vinay K, Sprung Juraj, Weingarten Toby N
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Pediatr Surg Int. 2018 Mar;34(3):335-341. doi: 10.1007/s00383-017-4212-2. Epub 2017 Nov 9.
Excessive narcotization in pediatric surgical patients has not been well characterized. This report describes the use of postoperative naloxone in pediatric patients.
Pediatric surgical patients from January 1, 2010, through June 30, 2016, who underwent general anesthesia and received naloxone within 48 h postoperatively were identified and matched 1:1 with controls by age, sex, and procedure. Cases and controls underwent retrospective chart review.
Forty-seven patients received naloxone, with a rate of 2.0 (95% CI 1.5-2.7) per 1000 anesthetics. Indications were respiratory depression (n = 19), facilitating extubation (n = 15), and reversing sedation (n = 13), and 44 cases received naloxone in a monitored environment. The median (interquartile range) naloxone dose was 4.0 (2.0-23.5) mcg/kg, and five patients (11%) later required subsequent naloxone treatments. Their characteristics were similar to controls, including opioid medications, except cases that had signs of respiratory depression before naloxone administration. The outcomes were similar, although more cases were admitted to the intensive care unit before naloxone administration. One patient died 13 days postoperatively of unrelated causes.
Postoperative naloxone administration in pediatric patients is rare. The observation that most administrations occurred in a monitored setting implies that at-risk patients had been appropriately identified and kept under closer surveillance.
小儿外科患者过度麻醉的情况尚未得到充分描述。本报告描述了小儿患者术后使用纳洛酮的情况。
确定2010年1月1日至2016年6月30日期间接受全身麻醉并在术后48小时内接受纳洛酮治疗的小儿外科患者，并按年龄、性别和手术进行1:1与对照组匹配。对病例和对照进行回顾性病历审查。
47例患者接受了纳洛酮治疗，每1000例麻醉中发生率为2.0（95%CI 1.5-2.7）。适应证为呼吸抑制（n = 19）、促进拔管（n = 15）和逆转镇静（n = 13），44例患者在监测环境中接受了纳洛酮治疗。纳洛酮剂量的中位数（四分位间距）为4.0（2.0-23.5）mcg/kg，5例患者（11%）随后需要再次接受纳洛酮治疗。他们的特征与对照组相似，包括使用阿片类药物，但在纳洛酮给药前有呼吸抑制体征的病例除外。结果相似，尽管更多病例在纳洛酮给药前被收入重症监护病房。1例患者术后13天死于无关原因。
小儿患者术后使用纳洛酮的情况很少见。大多数给药发生在监测环境中的观察结果表明，高危患者已得到适当识别并受到更密切的监测。
