227. Opioid Dosing and Sensitivity—Pediatrics

Question 1

What factors increase the risk of adverse effects of opioids in children?

Answer 1

Inaccurate pain assessment, immature metabolism, incorrect age-appropriate dosing

Negative side effects include nausea, pruritis, ileus, urinary retention, sedation, and respiratory depression.

Question 2

What are the commonly prescribed opioids for children?

Answer 2

Codeine, hydrocodone, oxycodone, morphine

For parenteral opioids, fentanyl and morphine are most commonly used.

Question 3

What are the two categories of pain?

Answer 3

Nociceptive pain, neuropathic pain

Question 4

What is nociceptive pain?

Answer 4

Pain from tissue injury and inflammation causing somatic or visceral pain

Question 5

What is neuropathic pain?

Answer 5

Pain caused by abnormal functioning of damaged sensory nerves

Question 6

How is pain severity commonly assessed in children under 11?

Answer 6

Using visual analogue pain scales

Question 7

What should be administered prior to opioids in the perioperative period?

Answer 7

Acetaminophen and nonsteroidal anti-inflammatory drugs

Question 8

What is the preferred dosing method for breakthrough pain in children?

Answer 8

As-needed dosing with frequent monitoring

Question 9

What should be avoided in opioid management for children?

Answer 9

Opioid infusions, respiratory depressants, use of opioids in high-risk individuals

Question 10

What is the recommended oral dosage of morphine for children?

Answer 10

0.3 mg/kg every 3–4 hours

Question 11

What is the recommended intravenous dosage of morphine for children?

Answer 11

0.1 mg/kg every 2–3 hours

Question 12

What is the recommended oral dosage of codeine for children?

Answer 12

0.5–1.0 mg/kg every 3–4 hours

Question 13

What is the recommended intramuscular dosage of codeine for children?

Answer 13

0.3–0.5 mg/kg every 4–6 hours

Question 14

What is the recommended intravenous dosage of fentanyl for children?

Answer 14

0.5–1.0 µg/kg every 1–2 hours

Question 15

What is the recommended intranasal dosage of fentanyl for children?

Answer 15

1.5 µg/kg, repeat once at 10 minutes

Question 16

What is the recommended oral dosage of hydrocodone for children?

Answer 16

0.1–0.15 mg/kg every 3–4 hours

Question 17

What is the recommended oral dosage of hydromorphone for children?

Answer 17

40–80 µg/kg every 3–4 hours

Question 18

What is the recommended intravenous dosage of hydromorphone for children?

Answer 18

10–20 µg/kg every 2–4 hours

Question 19

What is the recommended oral dosage of oxycodone for children?

Answer 19

0.1–0.2 mg/kg every 3–4 hours

Question 20

What is the most predictive physical examination finding of opioid intoxication?

Answer 20

Respiratory depression

Question 21

What are the keys to managing opioid intoxication?

Answer 21

Supportive care, gastrointestinal decontamination, naloxone

Question 22

What is the recommended naloxone dosage for children under 20 kg?

Answer 22

0.1 mg/kg IV (maximum 2 mg per dose)

Question 23

What is the recommended naloxone dosage for children 20 kg or greater?

Answer 23

2 mg IV

Question 24

How often should naloxone be repeated until improvement is noted?

Answer 24

Every 3 minutes

Question 25

What cumulative dose of naloxone in the first half hour is unlikely to yield additional benefit?

Answer 25

Greater than 10 mg

Question 26

What should be done if respiratory depression of unknown etiology fails to improve with naloxone?

Answer 26

Isolated opioid toxicity is unlikely