Opiate-induced respiratory depression in pediatric patients

OBJECTIVE: To describe 15 pediatric patients with opiate-induced respiratory depression. DESIGN: In-house adverse drug reaction (ADR) report forms were reviewed to identify any patients with suspected opiate-induced respiratory depression. Case review was then performed. SETTING: Large pediatric teaching hospital with regional specialties. PATIENTS: Fifteen patients aged 2 days to 17 years (median 14 mo). MAIN OUTCOME MEASURES: Respiratory depression resulting in apnea, hypoxia, cyanosis, reduced respiratory rate, or the need for naloxone following or during opiate administration was recorded. RESULTS: Fifteen patients experienced some degree of respiratory depression over the 3 years of surveillance. Treatment included naloxone (12 patients), admission to the pediatric intensive care unit (8), ventilation (5), and reduction in dosage (1). Predisposing factors for respiratory depression included an age of less than 1 year, excessive dosage, concurrent medical problems, concurrent drugs, and medication errors. CONCLUSIONS: Opiate-induced respiratory depression in pediatric patients occurs infrequently, but may have serious consequences. Opiates are potent analgesics that children require and should receive. Safe use of opiates in pediatric patients, however, depends on the dosage, route and method of administration, consideration of any predisposing factors, and adequate monitoring. This article highlights some of the problems with opiate use in children and gives some recommendations on bow these problems may be prevented.