What is the role of opioid analgesic agents in pediatric sedation?

Updated: May 08, 2018
  • Author: Wan-Tsu Wendy Chang, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Opioid analgesic agents are frequently used to control pain. They may be given either alone or in combination with sedative-anxiolytic agents. In some scenarios, they can be employed as hypnotic agents; however, the risk of respiratory depression is greater in this setting. The analgesic effect occurs at the mu opioid receptor.

Other opioid receptors (eg, kappa, delta) have been implicated in other effects (ie, some sedation and no amnestic properties). These effects are dose-related.

Whenever opioid analgesics are used, a reversal agent should be readily available. Naloxone is an opioid reversal agent that can be administered as 0.1 mg/kg intravenously (IV), intramuscularly (IM), subcutaneously (SC), or endotracheally (ET) every 2-3 minutes until response in children aged 5 years or younger or weighing 20 kg or less. In children older than 5 years or weighing more than 20 kg, the dosage is 2 mg IV, IM, SC, or ET every 2-3 minutes until response. Naloxone’s half-life is 1-2 hours. Rebound sedation and apnea may occur.

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