RESUMO
OBJECTIVES: To investigate whether geographic differences exist in perioperative opioid administration to children. AIM: To investigate whether perioperative fentanyl use for cleft lip and palate surgery varies between children of three different geographic regions. BACKGROUND: Differences have been found in perioperative opioid administration to children of differing ethnicity in the USA. Whether similar differences exist in perioperative opioid administration to children residing in different geographic regions is unknown. METHODS/MATERIALS: We retrospectively reviewed the medical records of ASA I children who underwent surgery under standardized general anesthesia between January 2010 and April 2011 during SMILE Network International mission trips to Africa, India and Central and South America. Perioperative administration of fentanyl was compared between these three locations. RESULTS: We analyzed data from 79 children who underwent surgery in Africa, 76 in India and 153 in Central and South America. Children in Central and South America were given <50% of the intraoperative amount of fentanyl (2.0 ± 1.2 mcg·kg(-1) ) administered to children in Africa (4.1 ± 2.4 mcg·kg(-1) ; P < 0.001) and children in India (4.3 ± 2.2 mcg·kg(-1) ; P < 0.001). Postoperatively, fentanyl was administered in equivalent doses to all groups. CONCLUSIONS: Children in Central and South America received less opioid intraoperatively than African and Indian children, under standardized anesthesia for cleft surgeries. Further research is necessary to elucidate the mechanisms underlying these group differences.
Assuntos
Analgésicos Opioides/uso terapêutico , Manejo da Dor/estatística & dados numéricos , Fatores Etários , Analgésicos Opioides/administração & dosagem , Análise de Variância , Anestesia , Criança , Pré-Escolar , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Uso de Medicamentos , Equador/epidemiologia , Fentanila/administração & dosagem , Fentanila/uso terapêutico , Geografia , Humanos , Índia/epidemiologia , Lactente , Cooperação Internacional , Quênia/epidemiologia , México/epidemiologia , Dor Pós-Operatória/tratamento farmacológico , Peru/epidemiologia , Estudos Retrospectivos , Fatores Sexuais , Uganda/epidemiologia , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: To investigate the effect of altitude on perioperative opioid requirements in otherwise healthy children. AIM: To investigate whether children living and having surgery at high altitude received different doses of fentanyl than those living and having surgery at sea level. BACKGROUND: Recent studies in animals (Anesthesiology, 105, 2006 and 715) and children with obstructive sleep apnea (Anesthesiology, 105, 2006 and 665; Anesthesiology 100, 2004 and 806) suggest that analgesic effects of exogenous opioids are enhanced by hypoxia. However, the effects of hypoxia on perioperative narcotic requirements in otherwise healthy children have not been previously reported. METHODS/MATERIALS: We reviewed retrospectively the opioid requirements of pediatric patients who underwent cleft lip or palate surgery during Smile Network International mission trips to Cusco and Lima, Peru between 2007 and 2009. Patients who had surgery at high altitude were compared to those who had surgery at sea level. All patients received a standardized anesthetic with intravenous fentanyl as the only perioperative opioid. RESULTS: Hundred and two patients had surgery at 3399 m above sea level (masl) (Cusco) and 169 patients had surgery at 150 masl (Lima). Patients at high altitude had significantly lower baseline oxygen saturations (92 ± 4% vs 98 ± 3%; P < 0.001) and received 40% less opioid (1.2 ± 0.8 vs 2.0 ± 1.4 µg·kg(-1) per h; P < 0.001) compared to patients at sea level. CONCLUSIONS: Opioid administration was reduced in otherwise healthy children with altitude-induced chronic hypoxia when compared to non-hypoxic children undergoing similar operations under similar anesthetic regimens. Whether this difference is due to altitude or altitude-induced hypoxia, requires further study.