Preprocedural opioids raise oxygen desaturation, vomiting risk in children

  • Bhatt M & al.
  • Acad Emerg Med
  • 01/01/2020

  • Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Children who receive opioids with preprocedural sedation were 4 times more likely to experience oxygen desaturation and twice as likely to experience vomiting than children who did not receive preprocedural opioids.

Why this matters

  • The risks for oxygen desaturation and vomiting were higher with morphine than fentanyl and when the opioid was received within 30 minutes of the procedure as opposed to an hour or longer in advance.

Study design

  • Secondary analysis of a prospective cohort (age, 0-18 years; n=6295) receiving sedation for a painful procedure (2010-2015).
  • Outcomes: oxygen desaturation, vomiting and positive pressure ventilation (PPV).
  • Funding: None disclosed.

Key results

  • 1806 children received a preprocedural opioid, of which 69.5%, 29.0%, and 0.4% children received morphine, fentanyl, and hydromorphone, respectively.
  • Compared to children who did not receive preprocedural opioids, those who received had higher incidences for:
    • oxygen desaturation: risk difference (RD), 4.3%; 95% CI, 2.9%-5.8%;
    • vomiting: RD, 2.0%; 95% CI, 0.7%-3.3%; and
    • need for PPV: RD, 1.5%; 95% CI, 0.7%-2.3%.
  • The highest incidence of adverse events was noted among children who were administered opioids within 30 minutes of sedation.
  • Timing of opioid administration was significantly associated with oxygen desaturation and vomiting (P<.0001 but not with ppv>

Limitations

  • Observational study.

Coauthored with Chitra Ravi, MPharm