title: Opioid-related adverse effects in children undergoing surgery: unequal burden on younger girls with higher doses of opioids.
abstract: OBJECTIVE
  Unpredictable interindividual variability in response to opioids results in inadequate analgesia and opioid-related adverse effects. The effects of the child's sex on opioid response have not been well studied. The aim of this study is to determine the effects of sex on opioid-related adverse effects in children undergoing tonsillectomy.
  
  
  METHODS
  Prospective observational clinical study.
  
  
  METHODS
  Outpatient pediatric surgery.
  
  
  METHODS
  Two hundred and seventy five children between 6 and 15 years of age undergoing outpatient tonsillectomy.
  
  
  METHODS
  All children received standard perioperative care with a standard intraoperative dose of morphine. Opioid-related analgesia and safety outcomes included incidences of respiratory depression (RD), postoperative nausea and vomiting (PONV) and incidence of prolonged stay in the, post-anesthesia recovery unit (PACU) due to opioid related adverse effects.
  
  
  RESULTS
  Given the small sample of minority population, we focused our study on 219 white children. Significant morphine effect was observed in girls but not boys for PONV (P = 0.001) and prolonged PACU stay due to PONV (P = 0.010). Although the overall incidence of RD is not statistically different between boys and girls, the incidence of RD (52% vs 32%) and PONV (43% vs 4%) tended to be more in white girls than boys as the total perioperative morphine dose increased to 0.3 mg/kg or more.
  
  
  CONCLUSIONS
  This study demonstrates that child's sex influences morphine's dose response and adverse effects. White girls have an unequal burden with higher incidences of PONV, RD, and prolonged PACU stays following tonsillectomy from PONV and RD as total morphine doses are increased.
authors.affiliation: Department of Anesthesia, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, 45040, USA.
authors.forename: Senthilkumar
authors.initials: S
authors.lastname: Sadhasivam
authors.affiliation: Department of Anesthesia, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, 45040, USA.
authors.forename: Vidya
authors.initials: V
authors.lastname: Chidambaran
authors.affiliation: Department of Anesthesia, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, 45040, USA.
authors.forename: Vanessa A
authors.initials: VA
authors.lastname: Olbrecht
authors.affiliation: Department of Anesthesia, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, 45040, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Costandi
authors.affiliation: Department of Anesthesia, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, 45040, USA.
authors.forename: Smokey
authors.initials: S
authors.lastname: Clay
authors.affiliation: Division of Human Genetics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, 45040, USA.|Division of Patient Services, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, 45040, USA.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Prows
authors.affiliation: Division of Human Genetics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, 45040, USA.|Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, 45040, USA.
authors.forename: Xue
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Division of Human Genetics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, 45040, USA.|Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, 45040, USA.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000009:adverse effects*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009020:Morphine / Q000009:adverse effects*; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced* / Q000453:epidemiology*; D012737:Sex Factors; D014068:Tonsillectomy
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Analgesia; Opioids; PONV; Respiratory Depression; Sex Differences; Tonsillectomy