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Clinical Summary

With recent opioids, more procedural sedation adverse events among children

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.
  • 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


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