PDF(Pubmed)
Abstract：
OBJECTIVE: Pediatric patients with sleep-disordered breathing (SDB) and obesity are at risk for opioid-induced respiratory depression. Although monitoring in the inpatient setting allows for early recognition of opioid-related adverse events, there is far less vigilance after ambulatory surgery as patients are discharged home. Guidelines for proper opioid dosing in these pediatric subsets have not been established. We sought to determine if at-risk children were more likely to receive doses of opioids outside the recommended range.
METHODS: Baseline opioid prescribing data for all outpatient surgery patients receiving an opioid prescription between January 2019 and June 2020 were retrospectively reviewed. Patients with SDB or obesity were identified. To obtain more information about prescribing practices, we analyzed patient demographics, size descriptors used for calculations, and prescription characteristics (dose, duration, and prescribing surgical service).
RESULTS: A total of 4674 patients received an opioid prescription after outpatient surgery. Of those, 173 patients had SDB and 128 were obese. Surgical subspecialties rendering most of the opioid prescriptions included otolaryngology and orthopedics. Obese patients were more likely (64%) to be prescribed opioids using ideal weight at higher mg/kg doses (>0.05 mg/kg; 83.3%; p < 0.0001). When providers used actual body weight, lower mg/kg doses were more likely to be used (53.7%; p < 0.0001). No prescriptions used lean body mass.
CONCLUSIONS: Overweight/obese children were more likely to receive opioid doses outside the recommended range. Variability in prescribing patterns demonstrates the need for more detailed guidelines to minimize the risk of opioid-induced respiratory complications in vulnerable pediatric populations.
METHODS: Baseline opioid prescribing data for all outpatient surgery patients receiving an opioid prescription between January 2019 and June 2020 were retrospectively reviewed. Patients with SDB or obesity were identified. To obtain more information about prescribing practices, we analyzed patient demographics, size descriptors used for calculations, and prescription characteristics (dose, duration, and prescribing surgical service).
RESULTS: A total of 4674 patients received an opioid prescription after outpatient surgery. Of those, 173 patients had SDB and 128 were obese. Surgical subspecialties rendering most of the opioid prescriptions included otolaryngology and orthopedics. Obese patients were more likely (64%) to be prescribed opioids using ideal weight at higher mg/kg doses (>0.05 mg/kg; 83.3%; p < 0.0001). When providers used actual body weight, lower mg/kg doses were more likely to be used (53.7%; p < 0.0001). No prescriptions used lean body mass.
CONCLUSIONS: Overweight/obese children were more likely to receive opioid doses outside the recommended range. Variability in prescribing patterns demonstrates the need for more detailed guidelines to minimize the risk of opioid-induced respiratory complications in vulnerable pediatric populations.
摘要：
目的：患有睡眠呼吸障碍（SDB）和肥胖的儿童患者存在阿片类药物引起的呼吸抑制风险。尽管在住院患者环境中进行监测可以早期识别阿片类药物相关的不良事件，随着病人出院回家，门诊手术后的警惕性大大降低。尚未建立这些儿科亚群中适当阿片类药物剂量的指南。我们试图确定有风险的儿童是否更有可能接受超出推荐范围的阿片类药物剂量。
方法：回顾性分析了2019年1月至2020年6月期间所有接受阿片类药物处方的门诊手术患者的阿片类药物处方基线数据。确定患有SDB或肥胖的患者。要获取有关处方实践的更多信息，我们分析了病人的人口统计,用于计算的大小描述符，和处方特征(剂量，持续时间,和开手术服务)。
结果：共有4674名患者在门诊手术后接受了阿片类药物处方。其中,173例患者患有SDB，128例肥胖。提供大多数阿片类药物处方的外科亚专科包括耳鼻喉科和骨科。肥胖患者更有可能（64%）服用理想体重的阿片类药物，剂量较高（>0.05mg/kg；83.3%；p<0.0001）。当提供者使用实际体重时，更可能使用较低的mg/kg剂量(53.7%;p<0.0001)。没有使用瘦体重的处方。
结论：超重/肥胖儿童更有可能接受超出推荐范围的阿片类药物剂量。处方模式的变化表明需要更详细的指南，以最大程度地减少脆弱的儿科人群中阿片类药物引起的呼吸道并发症的风险。
方法：回顾性分析了2019年1月至2020年6月期间所有接受阿片类药物处方的门诊手术患者的阿片类药物处方基线数据。确定患有SDB或肥胖的患者。要获取有关处方实践的更多信息，我们分析了病人的人口统计,用于计算的大小描述符，和处方特征(剂量，持续时间,和开手术服务)。
结果：共有4674名患者在门诊手术后接受了阿片类药物处方。其中,173例患者患有SDB，128例肥胖。提供大多数阿片类药物处方的外科亚专科包括耳鼻喉科和骨科。肥胖患者更有可能（64%）服用理想体重的阿片类药物，剂量较高（>0.05mg/kg；83.3%；p<0.0001）。当提供者使用实际体重时，更可能使用较低的mg/kg剂量(53.7%;p<0.0001)。没有使用瘦体重的处方。
结论：超重/肥胖儿童更有可能接受超出推荐范围的阿片类药物剂量。处方模式的变化表明需要更详细的指南，以最大程度地减少脆弱的儿科人群中阿片类药物引起的呼吸道并发症的风险。
