Adenotonsillectomy, Opioid, OSA
Conditions
Brief summary
Children OSA exhibit varying responses to opioids. It is unknown if the degree of intermittent hypoxemia results in different opioid sensitivity
Detailed description
Ventilatory suppression in children following opioid administration is of obvious concern, especially following routine surgical procedures (i.e. adenotonsillectomy). It is thought that patients with obstructive sleep apnea (OSA) have increased sensitivity to opioids, and especially in opioid naïve patients. Recent evidence in children suggests that patients with moderate to severe OSA may not predispose patients to increased opioid sensitivity in the form of respiratory depression when compared with patients that do not have OSA. However, what is not known is wether the degree of hypoxemia experienced by patients effects the opioid sensitivity. The aim of this study is to identify if children with known OSA experience a difference in opioid induced respiratory depression based on the degree of hypoxemia.
Interventions
DRUGFentanyl Citrate
Ventilatory response to fentanyl in patients with OSA Specifically: respiratory changes, CO2, RR, TV
Sponsors
University of Houston
Children's Hospital of Philadelphia
Wake Forest University
Baylor College of Medicine
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
SINGLE (Subject)
Masking description
The participant will be unaware of the arm
Intervention model description
2 groups will be identified- 1. patients with sleep study O2 nadir \>85% 2. patients with sleep study O2 nadir \<85%
Eligibility
Sex/Gender
ALL
Age
2 Years to 8 Years
Healthy volunteers
No
Inclusion criteria
* Patients undergoing tonsillectomy or adenotonsillectomy * Ages 2 to up to 8 years * Preoperative sleep study demonstrating obstructive sleep apnea * Intubation without medication (e.g. no propofol prior to intubation) * Requirement for airway instrumentation: LMA or ETT * Inhalation induction of anesthesia
Exclusion criteria
* No obstructive sleep apnea * Central sleep apnea events \>5/hour * IV induction of anesthesia * Syndromic patients * Known or suspected difficult airway * Allergy to Fentanyl * Known cardiovascular medications * Pulmonary hypertension * Total intravenous anesthesia required * Parental refusal
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Respiratory depression following opioids | respiratory rate measured at each minute for 10 consecutive minutes following opioid administration | Identification of respiratory depression following fentanyl administration by recording the respiratory rate prior to and 10 minutes following fentanyl administration |
Countries
United States
Outcome results
None listed