title: Perioperative opioid administration in children with and without developmental delay undergoing outpatient dental surgery.
abstract: OBJECTIVE
  Prior research has indicated that children with developmental delay (DD) experience qualitative and quantitative differences in health care (Boulet et al., 2009). In the perioperative setting, there is concern that children with DD may be more likely to experience postoperative complications including agitation and nausea/vomiting than typically developing patients (TDP). Differences in the administration and dosage of perioperative opioids may contribute to this, however, empirical investigations are lacking. The purpose of this research was to compare the experience of postoperative nausea/vomiting and agitation, as well as to examine perioperative opioid administration, among children with DD as compared to TDP.
  
  
  METHODS
  Retrospective original research.
  
  
  METHODS
  Operating room, postanesthesia care unit.
  
  
  METHODS
  1145 patients (1-20.9years, ASA I-III, 23.9% with a history of DD) who had undergone outpatient dental surgery involving extraction/restorations under general anesthesia.
  
  
  METHODS
  Data was obtained and analyzed from the medical records of both DD and TDP across a five-year period. Data included the experience of agitation, nausea/vomiting, as well as perioperative medication administration.
  
  
  RESULTS
  Postoperative agitation and nausea/vomiting did not differ significantly between the DD and TDP groups. Children with DD were significantly less likely to receive opioids during both the intra and postoperative period (χ2=10.02, p=0.001 and χ2=8.08, p=0.003, respectively). Further, higher dosage of intraoperative opioids was predictive of reduced administration of postoperative opioids among TDP; however, no significant association was observed between the dosage of intraoperative opioids and administration of postoperative opioids in the DD group.
  
  
  CONCLUSIONS
  Children with DD experience similar rates of postoperative complications including nausea/vomiting and agitation as TDP. DD children were less likely to receive both intra and postoperative opioids than TDP. Importantly, while the dosage of intraoperative opioids was predictive of administration of postoperative opioids in the TDP group, this was not the case for the DD group. Clinical implications are discussed.
authors.affiliation: Pediatric Anesthesiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States. Electronic address: erin.conner.md@gmail.com.
authors.forename: Erin R
authors.initials: ER
authors.lastname: Conner
authors.affiliation: Psychology, Florida International University, 11200 SW 8th St, Miami, FL 33199, United States. Electronic address: emusser@fiu.edu.
authors.forename: Erica D
authors.initials: ED
authors.lastname: Musser
authors.affiliation: Pediatric Anesthesiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States. Electronic address: kelsey.colpitts@gmail.com.
authors.forename: Kelsey M
authors.initials: KM
authors.lastname: Colpitts
authors.affiliation: Pediatric Anesthesiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States. Electronic address: laochamr@ohsu.edu.
authors.forename: Dean L
authors.initials: DL
authors.lastname: Laochamroonvorapongse
authors.affiliation: Pediatric Anesthesiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States. Electronic address: kohj@ohsu.edu.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Koh
mesh_terms: D000293:Adolescent; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000150:complications*; D000071257:Emergence Delirium / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D012189:Retrospective Studies; D014081:Tooth Extraction / Q000009:adverse effects*
chemical_list: D000701:Analgesics, Opioid
keywords: Developmental delay; Intraoperative opioids; Pediatric anesthesia; Postoperative complications; Postoperative opioids