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Association between fentanyl test results and rescue morphine requirements in children after adenotonsillectomy

Journal title
Journal of anesthesia
Publication year
Li, Y. H.; Wang, X.; Zhou, Z. J.; Zhuang, P. J.

PURPOSE: Preoperative sleep study helps to predict post-adenotonsillectomy morphine requirements. However, in some institutions, many suspected children with obstructive sleep apnoea syndrome have an adenotonsillectomy without polysomnography assessments. This study investigated the relationship between the results of a fentanyl test performed before extubation and the postoperative morphine requirements in children after adenotonsillectomy. METHODS: Intravenous fentanyl (1 microg/kg) was given as a test before extubation when spontaneous ventilation was restored in 80 children aged 3-7 years who underwent adenotonsillectomy. The result was considered positive if the patient’s respiratory rate decreased >50% after the test. In the recovery room, pain was assessed every 10 min using the Children’s Hospital of Eastern Ontario Pain Scale. Rescue morphine (10 microg/kg) was given when the score was >/=6. RESULTS: The median [IQR (range)] cumulative morphine consumption rates for children with a positive result (n = 25) and a negative result (n = 52) were 30 (20, 40) and 50 (40, 50) microg/kg, respectively (P = 0.002). Eighty-eight percent of the positive-result patients and 48% of the negative-result patients were light consumers of morphine (cumulative dose <50 microg/kg) (P = 0.001). CONCLUSIONS: We conclude that children with a positive result after a fentanyl test require less morphine to achieve comfort than those with a negative result. CLINICALTRIALS. GOV ID: NCT02484222.

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