Li Yi-Hang, Wang Xuan, Zhou Zhi-Jian, Zhuang Pei-Jun
Department of Anesthesia, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.
J Anesth. 2018 Feb;32(1):77-81. doi: 10.1007/s00540-017-2433-0. Epub 2017 Nov 21.
Preoperative sleep study helps to predict post-adenotonsillectomy morphine requirements. However, in some institutions, many suspected children with obstructive sleep apnoea syndrome have an adenotonsillectomy without polysomnography assessments. This study investigated the relationship between the results of a fentanyl test performed before extubation and the postoperative morphine requirements in children after adenotonsillectomy.
Intravenous fentanyl (1 µg/kg) was given as a test before extubation when spontaneous ventilation was restored in 80 children aged 3-7 years who underwent adenotonsillectomy. The result was considered positive if the patient's respiratory rate decreased >50% after the test. In the recovery room, pain was assessed every 10 min using the Children's Hospital of Eastern Ontario Pain Scale. Rescue morphine (10 µg/kg) was given when the score was ≥6.
The median [IQR (range)] cumulative morphine consumption rates for children with a positive result (n = 25) and a negative result (n = 52) were 30 (20, 40) and 50 (40, 50) µg/kg, respectively (P = 0.002). Eighty-eight percent of the positive-result patients and 48% of the negative-result patients were light consumers of morphine (cumulative dose <50 µg/kg) (P = 0.001).
We conclude that children with a positive result after a fentanyl test require less morphine to achieve comfort than those with a negative result. CLINICALTRIALS.
NCT02484222.
术前睡眠研究有助于预测腺样体扁桃体切除术后的吗啡需求量。然而，在一些机构中，许多疑似患有阻塞性睡眠呼吸暂停综合征的儿童在未进行多导睡眠图评估的情况下就接受了腺样体扁桃体切除术。本研究调查了拔管前进行的芬太尼试验结果与腺样体扁桃体切除术后儿童术后吗啡需求量之间的关系。
对80例年龄在3至7岁接受腺样体扁桃体切除术的儿童，在恢复自主通气后拔管前给予静脉注射芬太尼（1μg/kg）作为试验。如果试验后患者呼吸频率下降>50%，则结果被视为阳性。在恢复室，每隔10分钟使用安大略东部儿童医院疼痛量表评估疼痛情况。当疼痛评分≥6分时，给予急救吗啡（10μg/kg）。
试验结果为阳性（n = 25）和阴性（n = 52）的儿童，吗啡累积消耗量的中位数[四分位间距（范围）]分别为30（20，40）和50（40，50）μg/kg（P = 0.002）。88%的阳性结果患者和48%的阴性结果患者为吗啡低消耗者（累积剂量<50μg/kg）（P = 0.001）。
我们得出结论，芬太尼试验结果为阳性的儿童比结果为阴性的儿童达到舒适状态所需的吗啡量更少。临床试验。
NCT02484222。
