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Safety and efficacy of ketorolac in children after cardiac surgery

  • Pediatric Original
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Abstract

Objective

To evaluate the nephrotoxic and opioid-sparing effects of ketorolac in children after cardiac surgery.

Design

A retrospective cohort study.

Setting

A Cardiac Critical Care Unit in a university-affiliated children’s hospital.

Subjects

Children less than 18 years of age who underwent low-risk cardiac surgery from July 2002 to December 2005.

Results

Among 248 children studied, 108 received ketorolac and 140 did not. The ketorolac group was older, included a larger proportion of atrial septum defect repairs and a smaller proportion of ventricular septum defect repairs compared to the control group. The median change in serum creatinine did not differ between the ketorolac group and the control group (% change [IQR]); 12% [1–25] increase versus 12% [−3 to 31] increase, P = 0.86. On postoperative day 0 or 1, the ketorolac group received less opioids than control group. There was no difference in duration of mechanical ventilation or in length of stay between groups.

Conclusion

Ketorolac started in the first 12 h after a low-risk cardiac surgery in children is not associated with a measurable difference in renal function. The data suggest that ketorolac may be effective in reducing the exposure to opioids. Further studies are required to define subsets of children after cardiac surgery who could safely benefit from ketorolac therapy to reduce pain.

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Abbreviations

ASD:

Atrial septum defect

CCCU:

Cardiac Critical Care Unit

VSD:

Ventricular septum defect

FLACC:

Faces, Legs, Activity, Cry, and Consolability

IQR:

Interquartile range

NSAID:

Nonsteroidal anti-inflammatory drug

POD:

Postoperative day

RACHS-1:

Risk adjustment for congenital heart surgery

RV–PA:

Right ventricle to pulmonary artery

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Acknowledgments

The authors would like to acknowledge Ms. Gail Williams for her help with the retrieval of data from Toronto Cardiovascular Surgery Database for Congenital Heart Surgery in Division of Cardiovascular Surgery, Hospital for Sick Children, and Karen Wong, BSc Pharm, from the Department of Pharmacy, Hospital for Sick Children, for the assistance in the literature search.

Conflict of interest statement

None.

Author information

Authors and Affiliations

  1. Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Miho Inoue & Shinya Ito

  2. Department of Cardiac Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Christopher A. Caldarone

  3. Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Helena Frndova, Peter N. Cox & Anne-Marie Guerguerian

  4. Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Peter N. Cox & Anne-Marie Guerguerian

  5. Department of Anesthesia, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Peter N. Cox

  6. Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Anne-Marie Guerguerian

  7. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada

    Anna Taddio

  8. Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Anna Taddio

Authors
  1. Miho Inoue
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  2. Christopher A. Caldarone
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  3. Helena Frndova
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  4. Peter N. Cox
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  5. Shinya Ito
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  6. Anna Taddio
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  7. Anne-Marie Guerguerian
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Corresponding author

Correspondence to Anne-Marie Guerguerian.

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Inoue, M., Caldarone, C.A., Frndova, H. et al. Safety and efficacy of ketorolac in children after cardiac surgery. Intensive Care Med 35, 1584–1592 (2009). https://doi.org/10.1007/s00134-009-1541-1

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  • DOI: https://doi.org/10.1007/s00134-009-1541-1

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