Unwanted effects

The key adverse effect of opioids in infants is respiratory depression. This may be guarded against by the following measures:

• regular monitoring of the patient:
  • rate of respiration
  • depth of respiration
  • level of sedation
• sufficient staffing for immediate resuscitation

Should respiratory depression occur, the following measures should be commenced:

• secure airway
• adequate oxygenation and ventilation
• stop or slow opioid infusion
• naloxone may be given every 3-5 minutes by slow IV injection at a rate of 2 æg/kg up to a maximum of 10 æg/kg. Its action is short-lived and so continued observation is essential.

Other adverse effects of opioids in infants include:

• gastric stasis
• vomiting
• constipation
• urinary retention
• increased intraluminal pressure in the gut - causes breakdown of anastomoses
• dependence after a period of several days / weeks - gradual weaning is required