Newly Published
Perioperative Medicine  |   March 2019
Opioid Sensitivity in Children with and without Obstructive Sleep Apnea
Author Notes
  • From the Department of Anesthesiology, Washington University in St. Louis, School of Medicine, St. Louis, Missouri (M.C.M., L.J., A.S., E.D.K.); and the Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina (E.D.K.).
  • Michael M. Todd, M.D., served as Handling Editor for this article. A preliminary version of this study entitled “Remifentanil in Children with and without Obstructive Sleep Apnea” was presented at the Society for Pediatric Anesthesiology Annual Meeting in Colorado Springs, Colorado, April 1–3, 2016.
    Michael M. Todd, M.D., served as Handling Editor for this article. A preliminary version of this study entitled “Remifentanil in Children with and without Obstructive Sleep Apnea” was presented at the Society for Pediatric Anesthesiology Annual Meeting in Colorado Springs, Colorado, April 1–3, 2016.×
  • Submitted for publication April 17, 2018. Accepted for publication January 28, 2019.
    Submitted for publication April 17, 2018. Accepted for publication January 28, 2019.×
  • Correspondence: Address correspondence to Dr. Montana: Washington University School of Medicine, 660 South Euclid Avenue, Box 8054, St. Louis, Missouri 63110. montana@wustl.edu.Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Central and Peripheral Nervous Systems / Ophthalmologic Anesthesia / Pain Medicine / Pediatric Anesthesia / Pharmacology / Respiratory System / Sleep Medicine / Opioid
Perioperative Medicine   |   March 2019
Opioid Sensitivity in Children with and without Obstructive Sleep Apnea
Anesthesiology Newly Published on March 8, 2019. doi:10.1097/ALN.0000000000002664
Anesthesiology Newly Published on March 8, 2019. doi:10.1097/ALN.0000000000002664
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Children with obstructive sleep apnea are at greater risk for postoperative hypoxia and other respiratory events as compared with children without this disorder

  • There is some reason to believe that children with obstructive sleep apnea may be at greater risk for opioid-induced respiratory depression due to increased sensitivity to the drugs

What This Article Tells Us That Is New:

  • The authors hypothesized that children with obstructive sleep apnea would be more sensitive to the effects of an opioid (remifentanil) on pupil size—a very good indicator of opioid effects

  • While remifentanil did reduce pupil size in the expected dose-related fashion, there were no differences between children with obstructive sleep apnea and those without

  • While the authors did not observe any differences in the effect of remifentanil on respiration, the study was not designed to examine this factor in detail

Background: Opioids are a mainstay of perioperative analgesia. Opioid use in children with obstructive sleep apnea is challenging because of assumptions for increased opioid sensitivity and assumed risk for opioid-induced respiratory depression compared to children without obstructive sleep apnea. These assumptions have not been rigorously tested. This investigation tested the hypothesis that children with obstructive sleep apnea have an increased pharmacodynamic sensitivity to the miotic and respiratory depressant effects of the prototypic μ-opioid agonist remifentanil.

Methods: Children (8 to 14 yr) with or without obstructive sleep apnea were administered a 15-min, fixed-rate remifentanil infusion (0.05, 0.1, or 0.15 μg · kg-1 · min-1). Each dose group had five patients with and five without obstructive sleep apnea. Plasma remifentanil concentrations were measured by tandem liquid chromatography mass spectrometry. Remifentanil effects were measured via miosis, respiratory rate, and end-expired carbon dioxide. Remifentanil pharmacodynamics (miosis vs. plasma concentration) were compared in children with or without obstructive sleep apnea.

Results: Remifentanil administration resulted in miosis in both non-obstructive sleep apnea and obstructive sleep apnea patients. No differences in the relationship between remifentanil concentration and miosis were seen between the two groups at any of the doses administered. The administered dose of remifentanil did not affect respiratory rate or end-expired carbon dioxide in either group.

Conclusions: No differences in the remifentanil concentration–miosis relation were seen in children with or without obstructive sleep apnea. The dose and duration of remifentanil administered did not alter ventilatory parameters in either group.