eprintid: 1537521
rev_number: 46
eprint_status: archive
userid: 608
dir: disk0/01/53/75/21
datestamp: 2017-01-27 12:26:48
lastmod: 2021-12-01 23:58:58
status_changed: 2017-04-04 15:48:10
type: article
metadata_visibility: show
creators_name: Jay, M
creators_name: Thomas, BM
creators_name: Nandi, R
creators_name: Howard, RF
title: Higher risk of opioid-induced respiratory depression in children with neurodevelopmental disability: a retrospective cohort study of 12,904 patients
ispublished: pub
divisions: UCL
divisions: B02
divisions: D13
divisions: G26
divisions: G25
keywords: Developmental disabilities, morphine, pain, postoperative, 
morphine, child, nurses, pain management, disability, opioids, respiratory depression, adverse event
note: Copyright © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. This is a pre-copyedited, author-produced version of an article accepted for publication in the British Journal of Anaesthesia following peer review. The version of record [Jay, M; Thomas, BM; Nandi, R; Howard, RF; (2017) Higher risk of opioid-induced respiratory depression in children with neurodevelopmental disability: a retrospective cohort study of 12,904 patients. British Journal of Anaesthesia, 118 (2) pp. 239-246. DOI: 10.1093/bja/aew403] is available online at: https://doi.org/10.1093/bja/aew403
abstract: BACKGROUND: Children with neurodevelopmental disabilities may be at risk of opioid-induced respiratory depression. We aimed to quantify the risks and effectiveness of morphine nurse-controlled analgesia (morphine-NCA) for postoperative pain in children with neurodevelopmental disabilities.

METHODS: We carried out a retrospective cohort study of 12 904 children who received postoperative i.v. morphine-NCA. Subjects were divided into a neurodevelopmental disability group and a control group. Rates of clinical satisfaction, respiratory depression, and serious adverse events were obtained, and statistical analysis, including multilevel logistic regression using Bayesian inference, was performed.

RESULTS: Of 12 904 patients, 2390 (19%) had neurodevelopmental disabilities. There were 88 instances of respiratory depression and 52 serious adverse events; there were no opioid-related deaths. The cumulative incidence of respiratory depression in the neurodevelopmental disability group was 1.09% vs 0.59% in the control group [odds ratio 1.8 (98% chance that the true odds ratio was >1)]. A significant interaction between postoperative morphine dose and neurodevelopmental disabilities was observed, with higher risk of respiratory depression with increasing dose. Satisfaction with morphine-NCA was very high overall, although children with neurodevelopmental disabilities were 1% more likely to have infusions rated as fair or poor (3.3 vs 2.1%, χ2P<0.001).

CONCLUSIONS: Children with neurodevelopmental disabilities were 1.8 times more likely to suffer respiratory depression, absolute risk difference 0.5%; opioid-induced respiratory depression in this group may relate to increased sensitivity to dose-relate respiratory effects of morphine. Morphine-NCA as described was an acceptable technique for children with and without neurodevelopmental disabilities.
date: 2017-02
date_type: published
publisher: Oxford University Press (OUP): Policy B
official_url: http://dx.doi.org/10.1093/bja/aew403
oa_status: green
full_text_type: other
language: eng
primo: open
primo_central: open_green
article_type_text: Article
verified: verified_manual
elements_id: 1204180
doi: 10.1093/bja/aew403
lyricists_name: Howard, Richard
lyricists_name: Jay, Matthew
lyricists_id: RHOWA91
lyricists_id: MAJAY93
actors_name: Howard, Richard
actors_id: RHOWA91
actors_role: owner
full_text_status: public
publication: British Journal of Anaesthesia
volume: 118
number: 2
pagerange: 239-246
issn: 1471-6771
citation:        Jay, M;    Thomas, BM;    Nandi, R;    Howard, RF;      (2017)    Higher risk of opioid-induced respiratory depression in children with neurodevelopmental disability: a retrospective cohort study of 12,904 patients.                   British Journal of Anaesthesia , 118  (2)   pp. 239-246.    10.1093/bja/aew403 <https://doi.org/10.1093/bja%2Faew403>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/1537521/1/Jay_Higher_risk_opioid-induced_respiratory_depression.pdf