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Do Pre-Procedure Opioids Make Pediatric Sedation Riskier?

April 2, 2020

Written by Clay Smith

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Opioids given prior to pediatric sedation increased the risk of oxygen desaturation, vomiting, and need for positive pressure ventilation (PPV), especially if given within 30 minutes of the sedation.

Why does this matter?
When opioids mix with sedatives, the risk of apnea increases. But pain must be treated upon arrival or before x-ray for many patients who may later need sedation. Does the timing of opioid administration matter?

Darned if you do…
This was a secondary analysis of a pediatric sedation study with 6,925 children 0-18 years. Of these, 29% had opioids prior to sedation. In this cohort of 1,806 patients, there was an increased risk of oxygen desaturation (4.5% increase), vomiting (2% increase), and need for PPV (1.5% increase). This was was greatest when opioids were given within 30 minutes of the sedation. By all means, treat pain. But if sedation is imminent, you may wish to hold. If opioids are needed prior to sedation, you may need to target a lower dose and be ready in case of apnea or vomiting.

Impact of Timing of Preprocedural Opioids on Adverse Events in Procedural Sedation. Acad Emerg Med. 2020 Mar;27(3):217-227. doi: 10.1111/acem.13913. Epub 2020 Jan 30.

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