title: Opioid use after cardiac surgery in children with Down syndrome.
abstract: OBJECTIVE
  To determine the cumulative opioid doses administered to patients with Down syndrome after cardiac surgery and compare them with patients without Down syndrome.
  
  
  METHODS
  Retrospective observational comparative study.
  
  
  METHODS
  PICU in a university-affiliated freestanding pediatric teaching hospital.
  
  
  METHODS
  Infants and children who presented to our institution for heart surgery after July 1, 2008, and met the following criteria: 1) no opioid medications for 48 hours prior to surgery, 2) sternotomy approach with primary closure, and 3) no additional operative procedures in the 5 days after surgery. All patients with Down syndrome were included, and patients without Down syndrome with similar age, type of cardiac lesion, and length of surgical procedure were selected in a ~2:1 ratio, blinded to opioid exposure.
  
  
  METHODS
  None.
  
  
  RESULTS
  Clinical and demographic data were extracted from electronic medical record data. Univariate analyses and multivariate linear regression modeling were performed to determine the influence of Down syndrome, patient characteristics, and clinical covariates on weight-adjusted opioid dose. The differences in median cumulative opioid doses between those with Down syndrome (n = 44) and those without Down syndrome (n = 77) were not significant in the first 24 hours (+0.39 mg/kg [95% CI, -0.45 to +1.39 mg/kg]) or 96 hours (+0.54 mg/kg [95% CI, -0.59 to +2.07 mg/kg]) after surgery. Age, cardiac bypass time, benzodiazepines, and neuromuscular blocking agents were significantly correlated with opioid dose, but Down syndrome, gender, pain score, creatinine, acetaminophen, nonsteroidal anti-inflammatory drugs, and steroid medications were not. Patients with Down syndrome had longer hospital stays; in multivariate analysis, higher opioid exposures in the first 96 hours after surgery and higher peak serum creatinine values correlated with longer hospitalization.
  
  
  CONCLUSIONS
  This cohort did not provide evidence for opioid resistance in patients with Down syndrome. Younger age, longer cardiac bypass time, exposure to benzodiazepines, and neuromuscular blockade did correlate with increased opioid doses after cardiac surgery.
authors: 1Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN. 2Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN. 3Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN. 4The University of Texas School of Biomedical Informatics at Houston, Houston, TX. 5Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, TN.
authors: Sara L
authors: SL
authors: Van Driest
authors: Anushi
authors: A
authors: Shah
authors: Matthew D
authors: MD
authors: Marshall
authors: Hua
authors: H
authors: Xu
authors: Andrew H
authors: AH
authors: Smith
authors: Tracy L
authors: TL
authors: McGregor
authors: Prince J
authors: PJ
authors: Kannankeril
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001569:Benzodiazepines / Q000627:therapeutic use; D002648:Child; D003404:Creatinine / Q000097:blood; D004314:Down Syndrome / Q000150:complications*; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use; D061646:Operative Time; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D009466:Neuromuscular Blocking Agents; D001569:Benzodiazepines; D003404:Creatinine
references: Am J Crit Care. 2010 Jan;19(1):55-61; quiz 62
references: 20045849
references: Paediatr Anaesth. 1998;8(3):229-33
references: 9608968
references: J Pediatr. 2008 Jan;152(1):15-9
references: 18154890
references: Am J Cardiol. 2011 Dec 1;108(11):1620-4
references: 21890079
references: J Thorac Cardiovasc Surg. 2002 Jan;123(1):110-8
references: 11782764
references: Anesth Analg. 1993 Oct;77(4):695-701
references: 8214651
references: Anesth Analg. 1998 May;86(5):958-63
references: 9585276
references: Pain. 2000 Oct;88(1):89-95
references: 11098103
references: Br J Anaesth. 2012 Feb;108(2):295-301
references: 22201181
references: Heart Rhythm. 2011 Dec;8(12):1900-4
references: 21740877
references: Pediatrics. 1988 Jan;81(1):102-10
references: 2962062
references: J Biomed Inform. 2009 Apr;42(2):377-81
references: 18929686
references: Pain. 2001 Aug;93(2):173-183
references: 11427329
references: J Intellect Disabil Res. 2009 May;53(5):419-25
references: 19228275
references: Expert Rev Pharmacoecon Outcomes Res. 2003 Jun;3(3):317-25
references: 19807379
references: J Pain Symptom Manage. 2001 Aug;22(2):672-87
references: 11495714
references: Br Med Bull. 1981 Sep;37(3):291-5
references: 6459813
references: Control Clin Trials. 1990 Apr;11(2):116-28
references: 2161310
references: Anesth Analg. 2002 Nov;95(5):1224-9, table of contents
references: 12401598
references: J Am Soc Nephrol. 2005 Nov;16(11):3365-70
references: 16177006
references: Birth Defects Res A Clin Mol Teratol. 2010 Dec;88(12):1008-16
references: 20878909
references: Clin J Am Soc Nephrol. 2011 Apr;6(4):856-63
references: 21212419
references: AANA J. 2005 Apr;73(2):103-7
references: 15835829