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.
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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.
| Type: | Article |
|---|---|
| Title: | Higher risk of opioid-induced respiratory depression in children with neurodevelopmental disability: a retrospective cohort study of 12,904 patients |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/bja/aew403 |
| Publisher version: | http://dx.doi.org/10.1093/bja/aew403 |
| Language: | English |
| Additional information: | 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 |
| Keywords: | Developmental disabilities, morphine, pain, postoperative, morphine, child, nurses, pain management, disability, opioids, respiratory depression, adverse event |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Neurosciences Dept UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Population, Policy and Practice Dept |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1537521 |
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