OPIATE-INDUCED RESPIRATORY DEPRESSION IN PEDIATRIC-PATIENTS

OBJECTIVE: To describe 15 pediatric patients with opiate-induced respi ratory depression. DESIGN: In-house adverse drug reaction (ADR) report forms were reviewed to identify any patients with suspected opiate-in duced respiratory depression. Case review was then performed. SETTING: Large pediatric teaching hospital with regional specialties. PATIENTS : Fifteen patients aged 2 days to 17 years (median 14 mo). MAIN OUTCOM E MEASURES: Respiratory depression resulting in apnea, hypoxia, cyanos is, reduced respiratory rate, or the need for naloxone following or du ring opiate administration was recorded. RESULTS: Fifteen patients exp erienced some degree of respiratory depression over the 3 years of sur veillance. Treatment included naloxone (12 patients), admission to the pediatric intensive care unit (8), ventilation (5), and reduction in dosage (1). Predisposing factors for respiratory depression included a n age of less than 1 year, excessive dosage, concurrent medical proble ms, concurrent drugs, and medication errors. CONCLUSIONS: Opiate-induc ed respiratory depression in pediatric patients occurs infrequently, b ut may have serious consequences. Opiates are potent analgesics that c hildren require and should receive. Safe use of opiates in pediatric p atients, however, depends on the dosage, route and method of administr ation, consideration of any predisposing factors, and adequate monitor ing. This article highlights some of the problems with opiate use in c hildren and gives some recommendations on bow these problems may be pr evented.