Department of Anesthesiology, Children's Hospital of Fudan University, Shanghai, China.
Paediatr Anaesth. 2020 Jan;30(1):57-62. doi: 10.1111/pan.13771. Epub 2019 Dec 4.
Children with severe obstructive sleep apnea syndrome (OSAS) are more sensitive to opioids. Identifying such children and reducing or even eliminating opioids are necessary but difficult. We have previously shown that patients sensitive to intraoperative fentanyl require less opioids postoperatively.
The objective of this study was to evaluate the performance of a postinduction fentanyl test in identifying severe obstructive sleep apnea syndrome.
A prospective, observational, assessor-blinded study was carried out with 104 sleep study assessed children undergoing elective adenotonsillectomy. Intravenous fentanyl (1 µg/kg) was administered as a test in nonpremedicated, spontaneously breathing, sevoflurane-induced patients before endotracheal intubation. The respiratory rates before and after fentanyl administration were studied. The primary outcome was the sensitivity and specificity of the postinduction fentanyl test in identifying severe OSAS compared with polysomnography.
A postinduction fentanyl test had a likelihood ratio of 7.2 (95% CI: 3.6-14.6) and an area under the curve value of 0.896 (95% CI: 0.821-0.947) to identify severe obstructive sleep apnea syndrome. The pragmatic cut-off value for the postinduction fentanyl test was found to be 50%. Using a reduction in respiratory rate of >50%, the postinduction fentanyl test detected severe OSAS with a sensitivity of 87%, a specificity of 88%, a positive predictive value of 85%, and a negative predictive value of 89%.
Our study showed that a postinduction fentanyl test had good predictive value in identifying severe obstructive sleep apnea syndrome and early postoperative adverse respiratory events and could provide a reference for postoperative analgesia in children undergoing adenotonsillectomy.
患有严重阻塞性睡眠呼吸暂停综合征（OSAS）的儿童对阿片类药物更为敏感。识别此类儿童并减少甚至消除阿片类药物是必要的，但却很困难。我们之前的研究表明，对术中芬太尼敏感的患者术后需要的阿片类药物较少。
本研究旨在评估诱导后芬太尼测试在识别严重阻塞性睡眠呼吸暂停综合征中的表现。
这是一项前瞻性、观察性、评估者盲法研究，共纳入 104 例经睡眠研究评估的择期行腺样体扁桃体切除术的儿童患者。在非预给药、自主呼吸、七氟醚诱导下的患者中，静脉给予芬太尼（1μg/kg）作为试验，然后进行气管内插管。研究芬太尼给药前后的呼吸频率。主要结局是诱导后芬太尼测试在识别严重 OSAS 方面的敏感性和特异性与多导睡眠图的比较。
诱导后芬太尼测试的可能性比为 7.2（95%CI：3.6-14.6），曲线下面积值为 0.896（95%CI：0.821-0.947），以识别严重 OSAS。诱导后芬太尼测试的实用截止值为 50%。使用呼吸频率下降>50%，诱导后芬太尼测试检测严重 OSAS 的灵敏度为 87%，特异性为 88%，阳性预测值为 85%，阴性预测值为 89%。
本研究表明，诱导后芬太尼测试在识别严重阻塞性睡眠呼吸暂停综合征和术后早期不良呼吸事件方面具有良好的预测价值，可为接受腺样体扁桃体切除术的儿童提供术后镇痛参考。
