Takeaway
- In children having procedural sedation, previously received opioid analgesia was tied to increased respiratory adverse event risk during sedation.
- A gap of ≤30 minutes between opioids and procedural sedation correlated with the highest risk.
Why this matters
- Sedatives, including ketamine, can depress respiratory function.
- A previous study from this group linked preprocedural opioid administration to higher risk for oxygen desaturation and need for positive pressure ventilation (PPV) during procedural sedation.
- This follow-up analysis establishes that timing matters.
Key results
- Risk difference (95% CIs) with prior opioids vs without:
- Desaturation: 4.3% (2.9%-5.8%).
- Vomiting: 2.0% (0.7%-3.3%).
- PPV: 1.5% (0.7%-2.3%).
- ORs (95% CIs) for an event with receiving opioid at 30 and 150 minutes prior, compared with 180 minutes prior:
- Desaturation: 1.87 (1.27-2.76) and 1.07 (1.00-1.14).
Study design
- Secondary analysis of multicenter prospective cohort study (n=6295).
- Authors compared adverse events during procedural sedation among children who received (n=1806) vs did not receive prior opioid analgesia.
- Outcomes:oxygen desaturation, vomiting, and PPV in relation to timing of opioid administration.
- Funding: Canadian Institutes of Health Research funded parent study.
Limitations
- Small number of PPV events.
- No adjustment for opioid administration route.
- Only most recent opioid dose considered.
References
References