Anesthesiology

The researches find that the Opioid 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 test.

The Opioid are a mainstay

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. 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 test.

This investigation tested the hypothesis that children with obstructive sleep apnea have an increase pharmacodynamic sensitivity to the miotic and respiratory depressant effects of the prototypic μ-opioid agonist remifentanil. Concerns for a heightened risk of opioid induced respiratory depression make the perioperative use of opioids in children with obstructive sleep apnea particularly challenging, if not controversial.

Induced respiratory depression

It has been suggest that they may be at risk from overdose if administer what otherwise be consider a normal dose of opioid. Indeed; some pediatric surgical centers automatically reduce by half the opioid dose of patients undergoing tonsillectomy for a diagnosis of obstructive sleep apnea; publish guidelines recommend decreasing opioid doses in all patients with sleep apnea; for fear of respiratory depression. 

Despite the widespread belief that obstructive sleep apnea increases opioid sensitivity; evidence to support this claim comes largely from either animal studies; or from human studies that are limit by their reliance on behavioral scores; rather than using objective markers of opioid sensitivity.
There is an unmet need to quantify whether there is opioid sensitivity in children with obstructive sleep apnea as compared to children without obstructive sleep apnea. The purpose of this study was to evaluate opioid pharmaco dynamics in pediatric patients with and without obstructive sleep apnea; using remifentanil as the prototype opioid.

Obstructive sleep apnea

They test the hypothesis that children with obstructive sleep apnea have increased pharmacodynamic sensitivity to remifentanil; compared to those without obstructive sleep apnea. Pupil constriction (miosis) ;is the most sensitive measure of opioid effects at sub anesthetic drug concentrations, and was used as an objective measure of opioid effect. Sensitivity to remifentanil was assessed using pupillometry; and also respiratory rate and end-expired carbon dioxide in pediatric patients with and without obstructive sleep apnea.