Effect of Opioids on Central Control of Ventilation in Children With Obstructive Sleep Apnea

Ventilatory suppression in children following opioid administration is of obvious concern, especially following routine surgical procedures (i.e. adenotonsillectomy). It is thought that patients with obstructive sleep apnea (OSA) have increased sensitivity to opioids, and especially in opioid naïve patients. Recent evidence in children suggests that patients with moderate to severe OSA may not predispose patients to increased opioid sensitivity in the form of respiratory depression when compared with patients that do not have OSA. However, what is not known is wether the degree of hypoxemia experienced by patients effects the opioid sensitivity. The aim of this study is to identify if children with known OSA experience a difference in opioid induced respiratory depression based on the degree of hypoxemia.

Inclusion criteria

• Patients undergoing tonsillectomy or adenotonsillectomy
• Ages 2 to up to 8 years
• Preoperative sleep study demonstrating obstructive sleep apnea
• Intubation without medication (e.g. no propofol prior to intubation)
• Requirement for airway instrumentation: LMA or ETT
• Inhalation induction of anesthesia

Exclusion criteria

• No obstructive sleep apnea
• Central sleep apnea events >5/hour
• IV induction of anesthesia
• Syndromic patients
• Known or suspected difficult airway
• Allergy to Fentanyl
• Known cardiovascular medications
• Pulmonary hypertension
• Total intravenous anesthesia required
• Parental refusal