Yi-Hang Li1, Xuan Wang2, Zhi-Jian Zhou1, Pei-Jun Zhuang1. 1. Department of Anesthesia, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China. 2. Department of Anesthesia, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China. 18017591058@163.com.
Abstract
PURPOSE: Preoperative sleep study helps to predict post-adenotonsillectomy morphine requirements. However, in some institutions, many suspected children with obstructive sleep apnoea syndrome have an adenotonsillectomy without polysomnography assessments. This study investigated the relationship between the results of a fentanyl test performed before extubation and the postoperative morphine requirements in children after adenotonsillectomy. METHODS: Intravenous fentanyl (1 µg/kg) was given as a test before extubation when spontaneous ventilation was restored in 80 children aged 3-7 years who underwent adenotonsillectomy. The result was considered positive if the patient's respiratory rate decreased >50% after the test. In the recovery room, pain was assessed every 10 min using the Children's Hospital of Eastern Ontario Pain Scale. Rescue morphine (10 µg/kg) was given when the score was ≥6. RESULTS: The median [IQR (range)] cumulative morphine consumption rates for children with a positive result (n = 25) and a negative result (n = 52) were 30 (20, 40) and 50 (40, 50) µg/kg, respectively (P = 0.002). Eighty-eight percent of the positive-result patients and 48% of the negative-result patients were light consumers of morphine (cumulative dose <50 µg/kg) (P = 0.001). CONCLUSIONS: We conclude that children with a positive result after a fentanyl test require less morphine to achieve comfort than those with a negative result. CLINICALTRIALS. GOV ID: NCT02484222.
PURPOSE: Preoperative sleep study helps to predict post-adenotonsillectomy morphine requirements. However, in some institutions, many suspected children with obstructive sleep apnoea syndrome have an adenotonsillectomy without polysomnography assessments. This study investigated the relationship between the results of a fentanyl test performed before extubation and the postoperative morphine requirements in children after adenotonsillectomy. METHODS: Intravenous fentanyl (1 µg/kg) was given as a test before extubation when spontaneous ventilation was restored in 80 children aged 3-7 years who underwent adenotonsillectomy. The result was considered positive if the patient's respiratory rate decreased >50% after the test. In the recovery room, pain was assessed every 10 min using the Children's Hospital of Eastern Ontario Pain Scale. Rescue morphine (10 µg/kg) was given when the score was ≥6. RESULTS: The median [IQR (range)] cumulative morphine consumption rates for children with a positive result (n = 25) and a negative result (n = 52) were 30 (20, 40) and 50 (40, 50) µg/kg, respectively (P = 0.002). Eighty-eight percent of the positive-result patients and 48% of the negative-result patients were light consumers of morphine (cumulative dose <50 µg/kg) (P = 0.001). CONCLUSIONS: We conclude that children with a positive result after a fentanyl test require less morphine to achieve comfort than those with a negative result. CLINICALTRIALS. GOV ID: NCT02484222.
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