Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
Children's Hospital of Eastern Ontario, Department of Anesthesiology and Pain Medicine, Ottawa, Canada.
J Clin Sleep Med. 2022 Oct 1;18(10):2405-2413. doi: 10.5664/jcsm.10120.
Obstructive sleep-disordered breathing is commonly treated with adenotonsillectomy. Our study objective was to describe perioperative opioid dosing in children with a range of medical complexity evaluated for obstructive sleep-disordered breathing undergoing adenotonsillectomy and to investigate its association with postoperative respiratory adverse events (PRAEs).
A retrospective chart review of children who underwent adenotonsillectomy and had preoperative polysomnography performed was conducted. PRAEs included requiring oxygen, jaw thrust, positive airway pressure, or mechanical ventilation. Multivariable logistic regression was performed to examine for associations between covariates and PRAEs.
The cohort included 374 children with obstructive sleep-disordered breathing, median (interquartile range) age 6.1 (3.9, 9.3) years; 344 (92%) had obstructive sleep apnea (apnea-hypopnea index > 1 events/h) while 30 (8%) had a normal polysomnogram (apnea-hypopnea index < 1 events/h). The median (interquartile range) postoperative morphine-equivalent dose administered was 0.17 (0.09, 0.25) mg/kg. Sixty-six (17.6%) experienced at least 1 PRAE. Multivariable modeling identified the following predictors of PRAE: younger age at surgery (odds ratio 0.90, 95% confidence interval 0.83, 0.98), presence of cardiac comorbidity (odds ratio 2.07, 95% confidence interval 1.09, 3.89), and presence of airway anomaly (odds ratio 3.48, 95% confidence interval 1.30, 8.94). Higher total apnea-hypopnea index and morphine-equivalent dose were associated with PRAE risk, and an interaction between these variables was detected ( = .01).
This study identified opioid dose in morphine equivalents to be a strong predictor of PRAE. Additionally, severity of obstructive sleep apnea and postoperative morphine-equivalent dose contributed together and independently to the occurrence of PRAEs. Attention to opioid dosing, particularly among medically complex children with obstructive sleep-disordered breathing, is required to mitigate risk of PRAEs.
Tsampalieros A, Murto K, Barrowman N, et al. Opioid dose and postoperative respiratory adverse events after adenotonsillectomy in medically complex children. . 2022;18(10):2405-2413.
阻塞性睡眠呼吸障碍通常采用腺样体扁桃体切除术进行治疗。本研究旨在描述接受腺样体扁桃体切除术的不同医疗复杂程度的阻塞性睡眠呼吸障碍患儿的围手术期阿片类药物剂量，并探讨其与术后呼吸不良事件（PRAE）的关系。
对接受腺样体扁桃体切除术并进行术前多导睡眠图检查的患儿进行回顾性图表审查。PRAE 包括需要吸氧、下颌推压、气道正压或机械通气。采用多变量逻辑回归分析协变量与 PRAE 之间的关系。
该队列包括 374 例阻塞性睡眠呼吸障碍患儿，中位（四分位间距）年龄为 6.1（3.9，9.3）岁；344 例（92%）患儿存在阻塞性睡眠呼吸暂停（呼吸暂停低通气指数>1 次/小时），30 例（8%）患儿多导睡眠图正常（呼吸暂停低通气指数<1 次/小时）。术后吗啡等效剂量中位数（四分位间距）为 0.17（0.09，0.25）mg/kg。66 例（17.6%）患儿至少发生 1 次 PRAE。多变量建模确定了 PRAE 的以下预测因素：手术时年龄较小（比值比 0.90，95%置信区间 0.83，0.98）、存在心脏合并症（比值比 2.07，95%置信区间 1.09，3.89）和存在气道异常（比值比 3.48，95%置信区间 1.30，8.94）。较高的总呼吸暂停低通气指数和吗啡等效剂量与 PRAE 风险相关，并且检测到这些变量之间存在交互作用（=0.01）。
本研究发现，吗啡等效剂量可作为 PRAE 的强预测因子。此外，阻塞性睡眠呼吸暂停的严重程度和术后吗啡等效剂量共同且独立地导致了 PRAE 的发生。需要关注阿片类药物的剂量，特别是在患有阻塞性睡眠呼吸障碍的医疗复杂儿童中，以降低 PRAE 的风险。
Tsampalieros A, Murto K, Barrowman N, et al. Opioid dose and postoperative respiratory adverse events after adenotonsillectomy in medically complex children.. 2022;18(10):2405-2413.
