Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, TX, USA.
Baylor College of Medicine, Houston, TX, USA.
Paediatr Anaesth. 2021 Sep;31(9):977-984. doi: 10.1111/pan.14228. Epub 2021 Jun 16.
Obstructive sleep apnea is a risk factor for respiratory depression following opioid administration as well as opioid-induced hyperalgesia. Little is known on how obstructive sleep apnea status is associated with central ventilatory depression in pediatric surgical patients given a single dose of fentanyl.
This was a single-center, prospective trial in children undergoing surgery requiring intubation and opioid administration. Sixty patients between the ages of 2-8 years presenting for surgery at Texas Children's Hospital were recruited. Twenty non-obstructive sleep apnea controls and 30 patients with moderate to severe obstructive sleep apnea met inclusion criteria. Following induction of general anesthesia and establishment of steady-state ventilation, participants received 1 mcg/kg intravenous fentanyl. Ventilatory variables (tidal volume, respiratory rate, end-tidal CO , and minute ventilation) were assessed each minute for 10 min. The primary outcome was the extent of opioid-induced central ventilatory depression over time by obstructive sleep apnea status when compared with baseline values. Secondary aims assessed the impact of demographics and SpO nadir on ventilatory depression.
We found no significant difference in percent decrease in respiratory rate (38.1% and 37.1%; p = .950), tidal volume (6.4% and 5.4%; p = .992), and minute ventilation (35.0 L/min and 35.0 L/min; p = .890) in control and obstructive sleep apnea patients, respectively. Both groups experienced similar percent increases in end-tidal CO (4.0% vs. 2.2%; p = .512) in control and obstructive sleep apnea patients, respectively.
In pediatric surgical patients, obstructive sleep apnea status was not associated with significant differences in central respiratory depression following a single dose of fentanyl (1 mcg/kg). These findings can help determine safe opioid doses in future pediatric obstructive sleep apneapatients.
阻塞性睡眠呼吸暂停是阿片类药物给药后呼吸抑制以及阿片类药物诱导性痛觉过敏的一个危险因素。对于接受单次芬太尼给药的小儿外科患者，阻塞性睡眠呼吸暂停状态与中枢性通气抑制之间的关联知之甚少。
这是一项在德克萨斯儿童医院接受手术且需要插管和阿片类药物给药的小儿患者中进行的单中心前瞻性试验。共招募了 60 名年龄在 2-8 岁之间的手术患者。20 名非阻塞性睡眠呼吸暂停对照组和 30 名中重度阻塞性睡眠呼吸暂停患者符合纳入标准。全身麻醉诱导和稳定通气建立后，参与者接受 1 mcg/kg 静脉注射芬太尼。在 10 分钟内每分钟评估一次通气变量（潮气量、呼吸频率、呼气末 CO 和分钟通气量）。主要结局是根据基线值比较阻塞性睡眠呼吸暂停状态下随时间推移阿片类药物诱导的中枢性通气抑制的程度。次要目标评估人口统计学和 SpO 最低值对通气抑制的影响。
我们发现，在呼吸频率（分别为 38.1%和 37.1%；p=0.950）、潮气量（分别为 6.4%和 5.4%；p=0.992）和分钟通气量（分别为 35.0 L/min 和 35.0 L/min；p=0.890）方面，对照组和阻塞性睡眠呼吸暂停患者的下降百分比没有显著差异。两组患者的呼气末 CO 分别增加了 4.0%和 2.2%（p=0.512）。
在小儿外科患者中，阻塞性睡眠呼吸暂停状态与单次芬太尼（1 mcg/kg）给药后中枢性呼吸抑制无显著相关性。这些发现有助于确定未来患有小儿阻塞性睡眠呼吸暂停患者的安全阿片类药物剂量。
