• Terri Voepel-Lewis, Deborah Wagner, Constance Burke, Alan R Tait, Jennifer Hemberg, Elsa Pechlivanidis, Shobha Malviya, and Akkeneel Talsma.
• Department of Anesthesiology, University of Michigan Health Systems, Ann Arbor, MI, USA. terriv@umich.edu
• Paediatr Anaesth. 2013 Feb 1;23(2):162-9.

ObjectivesExamine factors associated with opioid adverse drug events (ADE) in children.Specific AimsExamine whether adjuvant nonopioid use is associated with a decreased probability of opioid-ADEs and need for rescue.BackgroundOpioid-ADEs contribute to serious preventable harm for hospitalized children. Adjuvant nonopioid use may mitigate opioid risk postoperatively, yet few studies support this notion.MethodThis nested case-control study included children who required intervention or rescue from opioid-ADEs and procedure-matched controls. Data were recorded from medical records and primary outcomes included serious opioid-ADEs (over-sedation and respiratory depression) and need for rescue (e.g., naloxone, rapid response team). Hierarchical logistic regression (HLR) models examined relationships between factors and opioid-ADEs. Early clinical signs and symptoms of deterioration were examined.ResultsTwenty five children with opioid-ADEs and 98 children without events were included. ASA-PS remained an independent risk factor (odds ratio, 2.56 [1.09, 6.03]; P = 0.031), while adjuvant nonopioids a risk reduction factor for opioid-ADEs (OR, 0.16 [0.05, 0.47]; P = 0.001) and need for rescue (0.14 [0.04, 0.47]; P = 0.001). Supplemental oxygen use at PACU discharge was associated with an increased odds of opioid-ADEs (OR, 3.72 [1.35, 10.23]; P = 0.007) and need for rescue (5.5 [1.7, 17.82]; P = 0.002).ConclusionsFindings from this study suggest that strategies such as early use of adjuvant nonopioids may reduce risk of opioid-ADEs postoperatively. Furthermore, children who require supplemental oxygen early postoperatively may be at heightened risk of later events.© 2012 Blackwell Publishing Ltd.

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