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Assistant Professor of Pediatrics, Michigan State University, Hurley Medical Center, Flint, MI
PharmD, Pharmacy Clinical Coordinator, Hurley Medical Center
Associate Professor of Pediatrics, Michigan State University, Hurley Medical Center
Research Coordinator, Hurley Medical Center
Research Coordinator, Hurley Medical Center
Associate Professor of Pediatrics, Michigan State University, Hurley Medical Center
Reprints: Rashed A Hasan MD, Hurley Medical Center, One Hurley Plaza, Flint, MI 48503-5993, FAX 810/257-9717, Rhasan1{at}hurleymc.com
BACKGROUND: Data on the cardiorespiratory changes and complications following administration of naloxone in children are limited.
OBJECTIVE: To evaluate the cardiorespiratory changes and complications following naloxone treatment in children.
METHODS: The maximal changes in respiratory rate (RR), heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, and any complications within 1 and 2 hours following naloxone were tabulated.
RESULTS: One hundred ninety-five children received naloxone over 3 years. The mean ± SD age was 9.7 ± 6 years. The total doses of naloxone ranged from 0.01 to 7 mg (0.001–0.5 mg/kg body weight), with a median dose of 0.1 mg. Group 1 patients consisted of 116 (60%) children who were postoperative and had been given naloxone by an anesthesiologist; group 2 patients consisted of 79 (40%) children who received naloxone in the emergency department or pediatric intensive care unit. Patients in group 1 were older: 10.6 ± 5.3 versus 8.2 ± 6.7 years (p < 0.006), but received significantly lower doses of naloxone (0.09 ± 0.2 vs. 1.1 ± 0.76 mg; p < 0.001). When the entire cohort was evaluated, a significant increase in RR (15 ± 7 vs. 21 ± 8 breaths/min; p < 0.001), HR (102 ± 29 vs.107 ± 29 beats/min; p < 0.001), SBP (109 ± 17 vs. 115 ± 15 mm Hg; p < 0.001), and DBP (56 ± 10 vs. 60 ± 13 mm Hg; p < 0.001) within 1 hour following naloxone was noted. When the 2 groups were compared, only the changes in RR were greater in group 2 patients (6.8 ± 7.9 vs. 4.7 ± 5 breaths/min; p < 0.001) following naloxone. Systolic hypertension occurred in 33 of 195 (16.9%) of all patients, while diastolic hypertension occurred in 13 (6.6%) of all patients after naloxone. Only the incidence of diastolic hypertension was higher in group 2 compared with group 1 patients following naloxone (16% vs. 2%; p < 0.001). Hypertension resolved spontaneously. One child developed pulmonary edema and required positive pressure ventilation for 22 hours.
CONCLUSIONS: Moderate increases in RR, HR, and BP occur after naloxone administration to children, but development of more serious complications is rare.
Key Words: adverse effects, children, naloxone
Published Online, September 5, 2003. www.theannals.com, DOI 10.1345/aph.1C521
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