Recurrent hypoxemia in young children with obstructive sleep apnea is associated with reduced opioid requirement for analgesia
Recurrent hypoxemia in young children with obstructive sleep apnea is associated with reduced opioid requirement for analgesia
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DOI：
10.1097/00000542-200404000-00009
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发表时间：
2004-04-01
期刊：
影响因子：
8.8
通讯作者：
Moss, IR
中科院分区：
文献类型：
--
作者：
Brown, KA;Laferrière, A;Moss, IR
背景：儿童阻塞性睡眠呼吸暂停（OSA）常伴有睡眠期间反复发作的低氧血症。在发育中的动物中，中枢阿片神经肽含量高，并且阿片受体在反复缺氧后上调。作者假设，OSA导致的低氧血症反复发作的儿童可能改变了中枢阿片功能，这可能影响他们对阿片类药物的反应性。使用回顾性数据库，我们评估了年龄和术前氧饱和度与累积术后吗啡剂量的关系，这些吗啡剂量用于OSA儿童接受adonotonsidelytomy.Methods：纳入标准为：（1）OSA的adonotonsidelytomy;（2）无并发症;（3）术中给予短效阿片类药物;（4）在手术室醒来时气管内拔管;（5）在手术室清醒时气管内拔管。（5）吗啡作为胃肠外术后镇痛药。结果：46名儿童（16名女孩）符合纳入标准。年龄和术前动脉血氧饱和度（Sao（2））最低值，无论是单独（P = 0.023，P = 0.0003，分别）或组合（P = 0.00009），显示出与镇痛所需的吗啡剂量显著相关。其中4名患儿年龄为26.5 ± 13.2个月，术前SaO（2）最低值为70.3 ± 12.9%，术后完全不需要任何吗啡镇痛。作者推测，在与严重OSA相关的氧饱和度下降的儿童中，吗啡镇痛需求量减少可能与他们的年轻年龄有关，调节中枢阿片受体导致低氧血症复发。在评估儿童OSA时，术前测定SaO（2）最低值对于预测术后镇痛所需阿片类药物剂量很重要。
Background: Obstructive sleep apnea (OSA) in children is often associated with recurrent hypoxemia during sleep. in developing animals, central opioid neuropeptide content is high, and opioid receptors arc up-regulated after recurrent hypoxia. The authors hypothesized that children with recurrent hypoxemia due to OSA might have altered central opioid functionality that could affect their responsiveness to opioid drugs. Using a retrospective database, we assessed the relation of age and preoperative oxygen saturation to the cumulative postoperative morphine dose administered for analgesia in children with OSA undergoing adenotonsillectomy.Methods: Inclusion criteria were (1) adenotonsillectomy for OSA; (2) no concomitant pathology; (3) intraoperative administration of short-acting opioid drugs; (4) endotracheal extubation on awakening in the operating room; and (5) morphine as the parenteral, postoperative analgesic..Results: Forty-six children (16 girls) fulfilled the inclusion criteria. Age and preoperative arterial oxygen saturation (Sao(2)) nadir, either individually (P = 0.023, P = 0.0003, respectively) or in combination (P = 0.00009), exhibited a significant correlation to the morphine dose required for analgesia. Four of these children, aged 26.5 +/- 13.2 months, with a preoperative SaO(2) nadir of 70.3 +/- 12.9%, did not require any postoperative morphine for analgesia at all.Conclusions: The authors speculate that the reduced morphine requirement for analgesia in children displaying oxygen desaturation associated with severe OSA may be related to their young age and to an up-regulation of central opioid receptors consequent to recurrent hypoxemia. In evaluating OSA in children, preoperative determination of the SaO(2) nadir is important for predicting the postoperative opioid dosage required for analgesia.