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Paediatric anaesthesia · Dec 2010
Perioperative opioid requirements are decreased in hypoxic children living at altitude.
- Jennifer A Rabbitts, Cornelius B Groenewald, Niki M Dietz, Carmen Morales, and Jukka Räsänen.
- Department of Anesthesiology, Mayo Foundation for Education and Research, Rochester, MN 55905, USA. rabbitts.jennifer@mayo.edu
- Paediatr Anaesth. 2010 Dec 1; 20 (12): 1078-83.
ObjectivesTo investigate the effect of altitude on perioperative opioid requirements in otherwise healthy children.AimTo investigate whether children living and having surgery at high altitude received different doses of fentanyl than those living and having surgery at sea level.BackgroundRecent studies in animals (Anesthesiology, 105, 2006 and 715) and children with obstructive sleep apnea (Anesthesiology, 105, 2006 and 665; Anesthesiology 100, 2004 and 806) suggest that analgesic effects of exogenous opioids are enhanced by hypoxia. However, the effects of hypoxia on perioperative narcotic requirements in otherwise healthy children have not been previously reported.Methods/MaterialsWe reviewed retrospectively the opioid requirements of pediatric patients who underwent cleft lip or palate surgery during Smile Network International mission trips to Cusco and Lima, Peru between 2007 and 2009. Patients who had surgery at high altitude were compared to those who had surgery at sea level. All patients received a standardized anesthetic with intravenous fentanyl as the only perioperative opioid.ResultsHundred and two patients had surgery at 3399 m above sea level (masl) (Cusco) and 169 patients had surgery at 150 masl (Lima). Patients at high altitude had significantly lower baseline oxygen saturations (92 ± 4% vs 98 ± 3%; P < 0.001) and received 40% less opioid (1.2 ± 0.8 vs 2.0 ± 1.4 μg·kg(-1) per h; P < 0.001) compared to patients at sea level.ConclusionsOpioid administration was reduced in otherwise healthy children with altitude-induced chronic hypoxia when compared to non-hypoxic children undergoing similar operations under similar anesthetic regimens. Whether this difference is due to altitude or altitude-induced hypoxia, requires further study.© 2010 Blackwell Publishing Ltd.
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