Association of sleep disordered breathing symptoms with early postoperative analgesic requirement in pediatric ambulatory surgical patients

• Published in: International journal of pediatric otorhinolaryngology 2017-05, Vol.96, p.145-151
• Main Authors: Yang, Kamie, MD, Baetzel, Anne, MD, Chimbira, Wilson T., MD, FRCA, Yermolina, Yuliya, MD, Reynolds, Paul I., MD, Nafiu, Olubukola O., MD, FRCA, MS
• Format: Article
• Language: English
• Subjects: Adolescent; Ambulatory surgery; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Apnea; Child; Child, Preschool; Children and adolescents; Cross-Sectional Studies; Elective Surgical Procedures - statistics & numerical data; Female; Habitual snoring; Humans; Male; Otolaryngology; Pain, Postoperative - drug therapy; Pediatrics; Postoperative pain; Postoperative Period; Prospective Studies; Sleep Apnea Syndromes - diagnosis; Sleep disordered breathing
• ISSN: 0165-5876; 1872-8464
• DOI: 10.1016/j.ijporl.2017.03.019

Abstract Introduction Sleep disordered breathing (SDB) symptoms are associated with increased rates of opioid-induced respiratory depression as well as enhanced nociception. Consequently, practitioners often withhold or administer lower intraoperative doses of opioids out of concern for postoperative respiratory depression. Therefore, SDB may be a critical determinant of analgesic requirement in the post-anesthesia care unit (PACU). We investigated whether preoperative SDB classification was independently associated with need for PACU analgesic intervention in a cross-sectional sample of 985 children who underwent elective, painful ambulatory surgical procedures. Methods Using prospectively collected data, children aged 4-17yr were grouped into two categories based on whether or not they had symptoms of SDB. Perioperative variables were compared between the exposed and control groups using Chi-squared test for categorical or t-test for continuous variables. Logistic regression analysis was used to assess the association between SDB and the odds of requiring PACU IV opioids. Results Children with preoperative SDB symptoms (N=325) compared with the reference group of children who did not have these symptoms had higher rates of PACU analgesic intervention (47.1% vs. 37.4%; p=0.004) and higher mean arousal pain scores (3.7±3.5 vs.1.9±2.9; p