Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA.
Department of Anesthesiology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA.
Pediatr Cardiol. 2021 Jun;42(5):1170-1179. doi: 10.1007/s00246-021-02598-x. Epub 2021 Apr 19.
Adequate pain control is a critical component of the perioperative approach to children undergoing repair of congenital heart disease (CHD). The impact of specific anatomic and physiologic disturbances on the management of analgesia has been largely unexplored at the present time. Studies in other pediatric populations have found an association between chronic hypoxemia and an increased sensitivity to the effects of opioid medications. The purpose of this retrospective study was to examine perioperative opioid administration and opioid-associated adverse effects in children undergoing surgical repair of CHD, with a comparison between patients with and without chronic preoperative cyanosis. Patients between the ages of 2 and 5 years whose tracheas were extubated in the operating room were included and were classified in the cyanotic group if they presented for the Fontan completion. The primary outcomes of interest were intraoperative and postoperative opioid administration. Secondary outcomes included pain scores and opioid-related side effects. The study cohort included 156 patients. Seventy-one underwent the Fontan procedure, twelve of which were fenestrated. Fontan patients received fewer opioids intraoperatively (11.33 µg/kg fentanyl equivalents versus 12.56 µg/kg, p = 0.03). However, there were no differences with regards to opioid consumption postoperatively and no correlation between preoperative oxygen saturation and total opioid administration. There were no differences between groups with regards to the respiratory rate nadir, postoperative pain scores, or the incidence of opioid-related side effects. In contrast to other populations with chronic hypoxemia exposure, children with cyanotic CHD did not appear to have increased sensitivity to the effects of opioid medications.
充分的疼痛控制是先天性心脏病（CHD）患儿围手术期治疗的关键组成部分。目前，特定的解剖和生理紊乱对镇痛管理的影响在很大程度上尚未得到探索。在其他儿科人群的研究中发现，慢性低氧血症与阿片类药物作用的敏感性增加之间存在关联。本回顾性研究的目的是检查接受 CHD 手术修复的儿童围手术期阿片类药物的使用情况，以及与术前慢性发绀患者相比的阿片类药物相关不良反应。在手术室拔管的年龄在 2 至 5 岁之间的患者被纳入研究，并在接受 Fontan 术式的患者中被分类为发绀组。主要观察结果是术中及术后阿片类药物的使用。次要观察结果包括疼痛评分和阿片类药物相关的副作用。研究队列包括 156 名患者。其中 71 名患者接受了 Fontan 手术，其中 12 名患者进行了开窗术。Fontan 组患者术中接受的阿片类药物较少（芬太尼等效物 11.33 µg/kg 与 12.56 µg/kg，p = 0.03）。然而，术后阿片类药物的使用量没有差异，术前氧饱和度与总阿片类药物使用量之间也没有相关性。两组间呼吸频率最低值、术后疼痛评分或阿片类药物相关副作用的发生率均无差异。与有慢性低氧血症暴露的其他人群不同，患有发绀性 CHD 的儿童似乎对阿片类药物的作用不敏感。
